粉红色泡泡痰
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病例</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">又到了月黑风高的夜晚，今天轮到我值班。在<span style="color: black;">夜晚</span>12点的时候我正睡得迷迷糊糊的，<span style="color: black;">忽然</span>接到急诊<span style="color: black;">tel</span>，<span style="color: black;">tel</span>的那头是一个正在哭泣略带慌张的<span style="color: black;">青春</span>女性，她说她的爸爸胸闷、<span style="color: black;">呼气</span>困难，咳出了<span style="color: black;">非常多</span>粉红色的痰液！我立刻心里有<span style="color: black;">欠好</span>的预感，<span style="color: black;">可疑</span>是急性心肌梗死<span style="color: black;">引起</span>了急性左心衰。我立刻挂断<span style="color: black;">tel</span>，丝毫不敢耽误，赶紧赶到<span style="color: black;">病人</span>家中。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这是我<span style="color: black;">第1</span>次见到45岁的陈先生，他正端坐着胸痛并捂住胸口，大口的喘气、咳嗽伴痛苦的呻吟，咳出<span style="color: black;">海量</span>的粉红色<span style="color: black;">泡泡</span>痰，大致判断出他的病情很严重。我<span style="color: black;">必须</span>立即简单询问病史，他在4小时前突发<span style="color: black;">没</span><span style="color: black;">显著</span>诱因胸痛，为胸骨后<span style="color: black;">连续</span>性压榨样<span style="color: black;">病痛</span>，<span style="color: black;">病痛</span><span style="color: black;">没</span>放射到他处，<span style="color: black;">连续</span>约1小时，<span style="color: black;">自动</span><span style="color: black;">吃下</span>硝酸甘油和丹参滴丸后<span style="color: black;">没</span><span style="color: black;">显著</span>缓解。我立即判断有心肌梗死<span style="color: black;">快速</span>行心电图提示：急性心肌梗死，立即给予“阿司匹林、波利维口服”。询问既往病史，既往体健，有二尖瓣狭窄病史。<span style="color: black;">思虑</span>“急性心肌梗死、急性左心衰”急诊绿色通道送入我院。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-b172c2324fa30fd69e4f988e51de3b4e_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">关联</span><span style="color: black;">检测</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">陈先生入院后，<span style="color: black;">咱们</span>立刻安排查体：神志清楚，血压90/60mmHg，心率99次/分，脉搏99次/分。听诊双肺<span style="color: black;">发掘</span>双肺遍布湿啰音，<span style="color: black;">呼气</span>音低钝。心前区<span style="color: black;">没</span>隆起，心尖搏动正常，<span style="color: black;">心率</span>齐，心音低钝。<span style="color: black;">按照</span>症状和体征初步<span style="color: black;">思虑</span>心梗<span style="color: black;">引起</span>的左心衰急性<span style="color: black;">爆发</span>，于是<span style="color: black;">咱们</span>立即安排了心电图、急诊胸片、心肌酶、BNP及冠脉造影。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-29fd598f546483a0fc301ce9f3bce327_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-cc65c4b4b4e8d1adef62e03c05611a2d_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-0740c6b0eb1955cef68f0b8da3d646ee_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-e46b763eca03152ba8c2753f4361b3cd_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">结果<span style="color: black;">表示</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急诊心电图：急性心肌梗死</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">急诊胸片：急性肺水肿</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">心肌酶及BNP均<span style="color: black;">表示</span>阳性</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">冠脉造影示：左冠前降支近段次全闭塞。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">诊断及治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">思虑</span>到病情<span style="color: black;">严重</span>，陈先生<span style="color: black;">必须</span>立即行PCI治疗。<span style="color: black;">咱们</span><span style="color: black;">按照</span>冠脉造影结果<span style="color: black;">思虑</span>前降支为犯罪血管，于前降支近段<span style="color: black;">移植</span><span style="color: black;">药品</span>洗脱支架一枚。<span style="color: black;">病人</span><span style="color: black;">日前</span>存在急性左心衰，<span style="color: black;">必要</span>限制补液，立刻镇静、利尿、扩管等<span style="color: black;">办法</span>降低心脏负荷，减少心肌坏死。其他继续<span style="color: black;">根据</span>心肌梗死指南标准术后予以双抗（阿司匹林、氯吡格雷）<span style="color: black;">连续</span>抗血小板，他汀（辛伐他汀）调脂，ACEI或ARB（贝那普利）及美托洛尔抗心室重塑治疗。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">陈先生治疗后胸闷、气促症状<span style="color: black;">逐步</span>好转，<span style="color: black;">再也不</span>喘息和咳出粉红色<span style="color: black;">泡泡</span>痰。<span style="color: black;">咱们</span>复查心电图<span style="color: black;">发掘</span><span style="color: black;">无</span>继续恶化。复查胸片<span style="color: black;">发掘</span>肺水肿<span style="color: black;">逐步</span>减轻。复查心脏彩超提示：左室壁节段运动<span style="color: black;">反常</span>， 测EF:45％。术后1周正常出院，<span style="color: black;">咱们</span>嘱咐他常常过来复诊，1年后<span style="color: black;">必要</span>复查冠脉造影。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">感悟</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">咳粉红色<span style="color: black;">泡泡</span>痰<span style="color: black;">一般</span>见于急性左心<span style="color: black;">衰尽</span>，此时<span style="color: black;">病人</span>常<span style="color: black;">显现</span>胸闷、气促、咳嗽咳痰和端坐<span style="color: black;">呼气</span><span style="color: black;">乃至</span>胸痛，胸闷、气促、<span style="color: black;">呼气</span>困难等症状较为<span style="color: black;">明显</span>。而<span style="color: black;">导致</span>心力<span style="color: black;">衰尽</span>的病因有<span style="color: black;">非常多</span>，如<a style="color: black;">心肌</a>梗死、感染性心内膜炎、高血压急症、快速性<a style="color: black;"><span style="color: black;">心率</span>失常</a>或严重<a style="color: black;">缓慢性<span style="color: black;">心率</span>失常</a>、输血、输液<span style="color: black;">太多</span>过快等。其中心肌梗死较为<span style="color: black;">平常</span>，急性左心<span style="color: black;">衰尽</span>时的缺氧和严重<span style="color: black;">呼气</span>困难是致命的威胁，<span style="color: black;">首要</span>对症治疗救命，<span style="color: black;">必要</span>尽快缓解。急性心衰预后很差，住院病死率为3%，6个月再住院率约50%，1年病死率高达30%。<span style="color: black;">因此</span>对因治疗改善预后。</p>
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