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第106章 陶瑟征阳性VS低钙血症。(1 / 2)

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华主任点了点头,“很好,你很诚实。我给大家念一念你的检查结果吧。

心电图:窦性心律,V1-V4导联T波倒置,QT间期延长。

超声心动图:弥漫性室壁运动减弱,严重左心室功能不全,LVEF 20%。

血常规、钾钠氯结果正常。左心室功能不全。”

华主任看了看叶凡,“说说你看到结果后的分析,还有处理。”

叶凡深吸了口气,“这结果完全在我的意料之中。QT间期延长的原因有很多,除了遗传因素外,还有心力衰竭、冠脉供血不足、风湿热、电解质紊乱、药物影响等。

我已经确认过“左乙拉西坦片”没有明确的心脏毒性及延长QT间期作用;钾钠氯结果正常、目前无电解质紊乱依据;大概QT间期延长的原因就是心力衰竭。

综上分析,我认为心力衰竭大概就是心肌病导致的。至于心肌病的原因,我决定再查个心肌磁共振吧……”

华主任拿起桌上的茶杯喝了一口,看向下面的人群。

“来,说说你们对这个病例和叶凡医生处理的看法。”

下面没有人开口,也没人举手。

华主任直接使出了杀手锏——随机点名。

“田波,你起来说说你的看法。”

田波没想到自己这么倒霉第一个就被点到了。

惴惴不安的站了起来,开口说道:“我觉得我应该像叶凡老师学习,学习他耐心询问病史的好习惯,这样才不容易误诊漏诊。”

华主任点点头,笑了笑,“好,坐下。”

看到华主任的表情,田波松了口气,喜滋滋的坐了下去。

看样子,自己应该说到点子上了。

华主任又点了个人,老主治“丁宏”。

顾风对他有印象,当时和自己一起给小朋友缝合过。

丁宏倒不像田波那样心虚,站起来淡淡说道:

“我觉得叶凡处理比较严谨和正规,看不出来什么问题。”

华主任挥了挥手,示意他坐下。

他环视全场,还有没有人有什么想要说的。

顾风慢慢站了起来,淡淡说道:“我可能有点不一样的观点。”

华主任松了口气,这小子终于站出来了,不然这一台戏自己一个人唱多没有意思。

“小顾,说说你的看法吧。”

顾风点了点头,朗声说道:

“仅仅是“钾钠氯”结果正常就能排除电解质紊乱吗?低钾血症、低钙血症、低镁血症都是QT间期延长的重要原因。

而且一测血压就抽搐是很明显的陶瑟征(Trousseau征)阳性!陶瑟征,以血压计袖带包裹上臂,使袖带压力维持在收缩压与舒张压之间,5分钟之内手部出现痉挛症状为阳性,可能为碱中毒、低钙血症、低镁血症、低钾血症、高钾血症。

所以如果是我的话,会把钙、镁、磷这些电解质也测一下。”

华主任欣慰的点了点头,“不错,说的很对。先坐下吧,我们继续看看后面的情况。

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