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Abstract:肺血管疾病包括肺栓塞、肺动脉高压、各类肺血管畸形,其中特别是肺栓塞和肺动脉高压,正逐渐被定义为严重影响卫生保健负担的重要疾病。我国目前在这个领域,缺乏高水平的流行病学研究,缺乏训练有素的医疗科研队伍,虽然从业医师数量近几年逐年增加,但与冠心病等专业相比,与防治任务相比,特别是和发达国家相比,仍然非常薄弱。从日益增长的医疗任务角度,我国肺血管疾病防治亟待进一步加强。1需要加强肺血管病医疗队伍的建设因为在这个领域,国家不是需要几个专家,和几个专科医疗中心就能完成目前存在的医疗科研任务,而是争取做到每个大型区域性医疗中心都有一支研究型医疗队伍,负责本区域专科医师培训,本区域的临床研究,全国的协作研究

Abstract:Objective To compare N-terminal pro-brain natriuretic peptide (NT-proBNP) levels between patients with left or right ventricular dysfunction and to study the clinical significance of NT-proBNP in left and right ventricular dysfunction. Methods A total of 96 subjects were divided into four groups: the left ventricular systolic dysfunction group (n=31),the left ventricular diastolic dysfunction group (n=31),the right ventricular dysfunction group (n=14),and the normal control group (n=20). Plasma NT-proBNP concentration was measured by ANALYTICS E170 Immunity Analyzer and compared between left or right ventricular dysfunction patients. Results In the left ventricular systolic dysfunction group,the left ventricular diastolic dysfuncton group and the right ventricular dysfunction group,the concentrations of NT-proBNP were much higher than that in control group (98±84) ng/L,P=0.000. The concentration of NT-proBNP was the highest in the left ventricular systolic dysfunction group (2743±2277) ng/L,followed by the left ventricular diastolic dysfunction group (447±416) ng/L and the right ventricular dysfunction group (387±333) ng/L sequentially. Conclusion The concentration of NT-proBNP is much higher in patients with left ventricular dysfunction than in patients with right ventricular dysfunction,and higher in patients with left ventricular systolic dysfunction than in patients with left ventricular diastolic dysfunction.

Abstract:Objective To investigate the clinical effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) complicated with multiple organ dysfunction syndrome (MODS). Methods From January 2003 to December 2008,383 hospitalized patients with AMI and MODS in General Hospital of Shenyang Military Command were divided into PCI group (n=181) and drug treatment group (n=202). The baseline data,the incidence rate of each dysfunction organ,the number of dysfunction organs and the mortality were compared between the two groups. Results There were more AMI patients with elevated ST segment in PCI group than in drug treatment group (90.6% vs 83.2%; P=0.03). The other baseline data were identical between the two groups. The revascularization rate in PCI group was much higher than that in drug treatment group (98.3% vs 52.5%; P<0.01). The incidence rate of organ dysfunction,such as heart,lungs,kidneys,stomach and intestine,was not different between the two groups. But in liver,brain and hematological system,the organ dysfunction incidence rate was lower in PCI group than in drug treatment group (16.6% vs 27.2%,10.5% vs 18.8%,2.2% vs 7.4%; P<0.05). The incidence rate of 2 organs dysfunction was higher in PCI group than in drug treatment group (65.2% vs 54.5%; P=0.04). The incidence rate of 3 organs dysfunction was not different between the two groups. But the incidence rate of 4 or 5 organs dysfunction was lower in PCI group than in drug treatment group (9.4% vs 17.3%,2.2% vs 7.9%; P<0.05). The mortality in PCI group was much lower than that in drug treatment group (9.9% vs 36.1%; P<0.05). Conclusion Although patients with AMI and MODS have high risk and high mortality,the valid PCI treatment still displays satisfactory clinical effects.

Abstract:Objective To investigate the relationship of apoptosis and autophagy of vascular smooth muscle cells (SMC) with the pathogenesis of abdominal aortic aneurysm (AAA). Methods In situ terminal transferase-mediated dUTP nick end-labeling(TUNEL) was used to detect the apoptosis of SMC of AAA and human normal aorta. The expression of LC3 was measured by immunohistochemistry. RNA extraction from the tissue of AAA and human normal aorta was performed. The mRNA levels of autophagy-related genes Beclin1,Atg4b,Bnip3,and Vps34 are tested by RT-PCR. Results The number of TUNEL-positive SMC in AAA was higher than that in normal aorta (P<0.05). The expression level of LC3 protein was significantly increased in AAA compared with that in normal aorta (P<0.05). The mRNA expression levels of Beclin1,Atg4b,Bnip3 and Vps34 were markedly up-regulated in AAA compared with that in normal aorta (P<0.05). Conclusion The apoptosis and autophagy of vascular SMC play an important role in the pathogenesis of AAA.

Abstract:Objective To study the value of chronic diseases for early predicrion of pulmonary infection induced multiple organ dysfunction syndrome in the elderly (MODSE). Methods Medical record data from 393 retired veteran cadres aged over 60 years,living in Shijiazhuang region,were analyzed retrospectively,who were hospitalized due to pulmonary infection or suffered pulmonary infection during hospitalization in Bethune International Peace Hospital from January 2001 to December 2006. They were divided into MODSE and non-MODSE groups.χ2 test for fourfold table was used to analyze the difference in morbidity of chronic diseases between the two groups. Binary Logistic stepwise regression model was used to screen the chronic diseases with high risk of MODSE. Results Single factor analysis showed that chronic obstructive pulmonary disease,chronic respiratory failure,pulmonary fibrosis,pulmonary heart disease,coronary heart disease,chronic cardiac insufficiency,cerebrovascular disease,cervical spondylosis,chronic hepatitis and cirrhosis,diabetes,hyperuricemia,chronic renal failure and malignant tumor affected the morbidity of MODSE. Binary Logistic stepwise regression showed that chronic cardiac insufficiency,cerebrovascular disease,chronic obstructive pulmonary disease,chronic respiratory failure,pulmonary heart disease,pulmonary fibrosis,diabetes,chronic renal failure and malignant tumor were the high risk chronic diseases. Conclusion Chronic cardiac insufficiency,cerebrovascular disease,chronic obstructive pulmonary disease,chronic respiratory failure,pulmonary heart disease,pulmonary fibrosis,diabetes,chronic renal failure and malignant tumor are valuable in early prediction of MODSE induced by pulmonary infection.

Abstract:Objective To compare the metabolic syndrome (MS) definitions from International Diabetes Federation (IDF) and the Chinese Diabetes Society (CDS) respectively,and to investigate their difference and agreement rate for diagnosis of MS in middle aged and elderly population in Guangzgou region. Methods In 2004,1270 Guangzhou shipyard workers and 2082 peasants from 4 villages of Dashi District,Panyu,Guangzhou with age ≥ 35 years,were investigated. They were asked to fill a medical history questionnaire and their height,weight,waist circumference,blood pressure,and blood biochemical markers were also measured. The individuals with incomplete data were excluded. Finally,1266 workers,and 1658 peasants were analyzed. MS prevalence rate in two groups were calculated following the definitions from IDF and CDS respectively. Results (1) A total of 40.5% individuals met the MS definition both from IDF and from CDS; 34.6% individuals only met the MS definition from IDF but not from CDS; 24.9% individuals only met the definition from CDS,but not from IDF. MS diagnosis agreement rate reached up to 87% (urban 87.3%,rural 87.1%). Kapple was 0.501 (P<0.001). (2) Using definition either from CDS or IDF,MS prevalence rate was roughly at the same level in urban (15.5%,IDF definition; 14.6%,CDS definition) and rural areas (16.6%,IDF definition; 13.8%,CDS definition). But according to the definition from IDF,there were 105 urban residents and 160 rural residents who did not meet the diagnosis of MS,because their waist index did not meet the standard although other three indicators did. (3) MS prevalence rate was higher with CDS definition (16.1%) than with IDF definition (12.3%) in male; but in female,it was higher with IDF definition (20.1%) than with CDS definition (12.0%). (4) After the subjects were divided into 5 different age groups,including <40 years,40-49 years,50-59 years,60-69 years,and >70 years respectively,it was found that MS prevalence rate increased with age. However,in>70 years group,MS prevalence rate decreased with age. The MS prevalence rate was the highest in 60-69 age group. Conclusion The MS definition from IDF and CDS can give identical MS prevalence rate. But men are more sensitive to the definition from CDS,while women to definition from IDF. The elderly individuals are the main targets for prevention and treatment of MS.

Abstract:目的总结老年胸外伤患者院前急救经验。方法 60岁以上老年胸外伤患者78例,年龄60～89岁,平均(68.9±4.1)岁。致伤原因中跌伤与交通意外伤占80%;伤情分类中肋骨骨折发生率高达77%,约1/3合并有不同程度的头颅外伤;合并症中以心脑血管病为多。所有患者均在现场抢救后车载转送医院。结果呼救反应时间2～35min,平均(9.7±3.7)min;院前时间16min～4.5h,平均(38.5±9.5)min。无现场死亡及转送死亡;院内死亡5例,病死率为6.4%。结论只要掌握老年人胸部外伤的特点,进行快速、有效的院前干预,就能为进一步救治打下良好基础,为降低病死率和伤残率创造有利条件。

Abstract:Objective To investigate the relationship between the plasma level of B-type natriuretic peptide (BNP) and P-selectin(CD62P) in different types of coronary heart diseases (CHD) and its clinical significance. Methods A total of 105 subjects were divided into control group (group C,n=20) and CHD group according to the coronary angiography results. CHD group was further divided into stable angina pectoris (SA,n=21),unstable angina pectoris (UA,n=32) and acute myocardial infarction (AMI,n=32) subgroups according to the clinical diagnosis. Blood samples were taken from all patients before PCI. ELISA and flow cytometry were used to measure the plasma BNP and CD62P levels respectively.Results (1) Compared with group C,the plasma levels of BNP (283±42) ng/L vs (14±4) ng/L,P<0.05and CD62P (9.4±3.6)% vs (3.3±1.4)%,P<0.05raised obviously in CHD group. (2) There were significant differences in the plasma levels of BNP and CD62P among different CHD subgroups (F=21.5,13.6,P<0.01),with the levels highest in AMI subgroup. (3) Pearson correlation analysis showed that BNP was positively correlated with high sensitive C-reactive protein (hs-CRP,r=0.62,P<0.01) and CD62P(r=0.23,P<0.05),and negatively correlated with left ventricular ejection fraction (LVEF,r=-0.42,P<0.01); CD62P was positively correlated with hs-CRP(r=0.33,P<0.05)and not correlated with LVEF(r=0.13,P>0.05). (4) Multivariate regression analysis revealed that both hs-CRP and LVEF were independently correlated with BNP (β=0.609 and -0.412,respectively,P<0.01). Conclusion (1) BNP and CD62P are involved in the development of CHD; CD62P may reflect the coronary artery inflammation; they are correlated with the instability of plaque; they have significance in guiding diagnosis,treatment and risk stratification of CHD. (2) The plasma level of BNP is independently correlated with CRP and left ventricular systolic function respectively.

Abstract:Objective To assess the value of global systolic strain in the evaluation of left ventricular systolic function by two-dimensional speckle tracking imaging. Methods Two-dimensional echocardiography was performed in 52 patients with heart failure and 30 healthy control subjects. The systolic longitudinal strain (LS),radial strain (RS) and circumferential strain (CS) were measured in 18 segments of left ventricular using 2D strain software. The global longitudinal strain (GLS),global radial strain (GRS) and global circumference strain (GCS) were calculated as the average of left ventricular 18 segmental LS,RS and CS values respectively. Left ventricular ejection fraction (LVEF) was also measured by the conventional two-dimensional echocardiography. Receiver operation characteristic curves (ROC) were obtained for GLS,GCS and GRS respectively to the cut-off values.Results The values of GLS,GRS and GCS in heart failure group were significantly decreased compared with those in control group (P<0.05). ROC curves showed that the areas under the GLS and GCS curves were 0.950 and 0.939,respectively. The corresponding GLS and GCS cut-off values were -13.12% and -13.86%. The sensitivity and specificity of GLS and GCS for diagnosis of heart dysfunction were 90.0%/94.4% and 93.3%/83.3% respectively. The area under GRS curve was just 0.17 (< 0.5),which had little diagnosis value in evaluating left ventricular systolic dysfunction.Conclusion Two-dimensional global systolic strain may help to evaluate left ventricular systolic function,in which,GLS and GCS have a significant value of diagnosis in heart dysfunction.?更多

Abstract:Objective To study the effect of short-term intensive insulin therapy on beta-cell function in different courses of newly diagnosed type 2 diabetic patients. Methods Ninety-one newly diagnosed type 2 diabetic patients with fast blood glucose (FBG) >11.1 mmol/L received insulin intensive therapy for 4 weeks. We analyzed the data from 41 cases within 1 week course (group A) and 28 cases over 12 weeks course (group B). All 69 patients underwent glucose tolerance test. Insulin,glycosylated glycohemoglobin (HbA1c),albumin,blood pressure,lipid level and uric acid were also tested before and after intensive insulin therapy. HOMA-β and HOMA-IR were calculated. Results After insulin intensive therapy,FBG,albumin,HbA1c,triglyceride,low density lipoprotein-ch,systolic blood pressure,and diastolic blood pressure decreased dramatically and uric acid increased markedly in all patients (P<0.05),while there was no difference between group A and B. There was improvement in HOMA-β but not in HOMA-IR after therapy. The improvement of HOMA-β in group A was much better than that in group B. Conclusion The shorter the course of diabetes mellitus is,the better the beta-cell function will be improved. Early awareness and early treatment of type 2 diabetes are strongly recommended.

Abstract:目的探索口服β受体阻滞剂对慢性心力衰竭急性失代偿患者的血流动力学的影响。方法将应用Swan-Ganz导管监测治疗的慢性心力衰竭急性失代偿患者按照是否在使用β受体阻滞剂分成β受体阻滞剂组和无β受体阻滞剂组,对比分析院内死亡率、住院时间、住监护室时间及血流动力学监测指标。结果共152例患者,男127例,女25例,β受体阻滞剂组131例,无β受体阻滞剂组21例,β受体阻滞剂组与无β受体阻滞剂组的性别、年龄、NYHA心功能分级、心率、血压、病因、伴随疾病、用药情况等基线资料基本一致。两组间β受体阻滞剂的使用不会增加院内死亡率(P=0.14),延长住院时间(P=0.54)及住监护室时间(P=0.716)。对肺毛细血管楔压、心指数、肺血管阻力指数、体循环阻力指数等的影响无统计学差异,能明显降低肺动脉收缩压(P=0.018)、肺动脉舒张压(P=0.031)、平均肺动脉压(P=0.042)、肺血管阻力(P=0.044)、中心静脉压(P=0.000)。结论口服低剂量的β受体阻滞剂不会恶化慢性心力衰竭急性失代偿患者血流动力学状态,在心率较快,血压可耐受的情况下可谨慎地使用。

Abstract:Objective To analyze retrospectively the application of Perclose Proglide vascular closure devices in patients with marked distortion of iliac artery after coronary artery angiography (CAG). Methods Eighty patients with marked distortion of iliac artery were selected from 3760 CAG cases from August 2005 to December 2007. Only when 0.038" extra-support wire(TERUMO:Radifocus Guide Wire M) and/or 23 cm long sheeth (ST-Jude Medical) was used,CAG achieved all success for 80 patients. Perclose Proglide vascular closure devices were used in 35 cases,and the other 45 cases received traditional manual compression. The hematoma,bleeding,aneurysm and infection rate were compared between the two groups. Results All patients who used Perclose Proglide vascular closure devices achieved success,with 2 cases of hematoma and 1 case of bleeding,without aneurysm and infection. The hematoma,bleeding and aneurysm in control group were 3,1 and 1 cases,respectively. There was no difference between two groups. Conclusion It is safe and effective to use Perclose Proglide vascular closure devices in patients with marked distortion of iliac artery after CAG.

Abstract:Objective To explore the changes in plasma tissue factor(TF),tissue factor pathway inhibitor(TFPI),interleukin-18(IL-18),and interleukin-10(IL-10) in patients with coronary heart disease(CHD),and to investigate their roles in the development of CHD and their mutual relationships. Methods A total of 121 patients were divided into control group (n=25) and CHD group (n=96). CHD group was further divided into acute myocardial infarction (AMI) subgroup (n=33),unstable angina pectoris (UAP) subgroup (n=33) and stable angina pectoris (SAP) subgroup (n=30). Plasma TF,TFPI,IL-18,IL-10 levels were detected by enzyme-linked immunosorbent assay (ELISA). Results The plasma concentrations of TF,TFPI and TF/TFPI ratio were higher in CHD group than in control group; they were higher in AMI subgroup than in UAP and SAP subgroups,and higher in UAP subgroup than in SAP subgroup. The plasma concentrations of IL-18,IL-10,and IL-18/IL-10 ratio in CHD group were higher than those in control group. The plasma concentrations of IL-18 and IL-18/IL-10 ratio were higher in AMI subgroup than in UAP and SAP subgroups,and higher in UAP subgroup than that in SAP subgroup. The plasma concentration of IL-10 in AMI and UAP subgroups was lower than that in SAP subgroup. In CHD group,plasma TF was positively correlated with IL-18 (r=-0.302 2,P<0.01) and TF/TFPI ratio was also positively associated with IL-18/IL-10 (r=0.3494,P=0.01). Conclusion Hypercoagulability activity and high inflammatory response exist in CHD patients; further more,they parallel with the severity of the disease. The positive relationship between coagulation factors and inflammatory factors suggests that they play an important role in the development of CHD and be used to evaluate the severity of the disease.

Abstract:Objective To evaluate the impact of reperfusion-time on left ventricular remodeling and long-term mortality in patients with anterior acute myocardial infarction (AMI) undergoing successful primary percutaneous coronary intervention(PCI). Methods A total of 113 patients with primary anterior AMI were enrolled,in whom coronary angiography revealed a total occlusion of infarct-related artery (IRA) (TIMI 0-1). According to the reperfusion-time for PCI,the subjects were divided into three groups: group A (35 patients),the reperfusion-time <6 h; group B (40 patients),the reperfusion-time between 6 and 12 h; group C (38 patients),the reperfusion-time between 12 and 24 h. All patients underwent the coronary artery angiography and left ventricular angiography both immediately and at 6 months. The left ventricular end diastolic volume,left ventricular end systolic volume,left ventricular ejection fraction,cardiac output,and cardiac index were compared among the three groups. Main adverse cardiac events (MACE) during one year follow-up,including angina,heart failure,myocardial infarction,and cardiac death were also compared among the groups. Results There was no difference in parameters of heart function among the three groups immediately after successful reperfusion. At 6 months,the heart function in group A and B was improved,but not in group C. During one year follow up,there was no death or recurrence of myocardial infarction in group A and B. There was no difference in angina incidence among the three groups. There was higher incidence of heart failure and death in group C than in group A and B. Conclusion Early PCI in patients with anterior AMI is recommended. It can achieve IRA revascularization,prohibit left ventricular remodeling,improve heart function,and decrease incidence of MACE,thus long-term prognosis can be improved.

Abstract:Objective To study the correlation between hyperuricemia (HUA) and other risk factors of coronary heart disease (CHD) in the elderly. Methods Totally 300 elderly CHD patients hospitalized from 2007 to 2009 in People’s Hospital,Peking University,were selected. Serum levels of uric acid,fasting blood glucose (FBG),blood pressure,total cholesterol,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol and triglycerides were detected. The subjects’ age,sex,smoking history and body mass index (BMI) were also recorded. The correlation between HUA and other risk factors of CHD were analyzed. Results Among 300 CHD cases,HUA was confirmed in 192 cases,and 108 cases had normal uric acid levels. Logistic analysis showed that the level of serum uric acid was positively correlated with age,sex,blood pressure,serum lipid and BMI. The blood pressure,serum lipid levels and BMI were significantly higher in patients with HUA than in patients with normal uric acid level. Conclusion There is a high prevalence of HUA in CHD patients. HUA frequently co-exists with the disorders of blood pressure,disturbance of serum lipid and glucose metabolism. HUA is one of the risk factors for CHD.

Abstract:Objective To analyze the number,distribution,drug use and drug cost of hypertension patients in outpatient departments in Fuxing Hospital Affiliated to Capital Medical University,and to analyze the administration of β receptor blockers in the hospital. Methods Donghua Hospital Information System was used to collect the data of 22 399 hypertension patients in outpatient departments from July 26,2007 to January 31,2008,including sex,age,blood pressure grade,drug administration,and drug cost. According to the specific alities of the physicians in outpatient department they visited,the patients were divided into 3 groups: cardiovascular group,non-cardiovascular group,and non-internal medicine group. The used antihypertensive drugs were divided into 8 types,including β receptor blockers,α receptor blockers,angiotensin-converting enzyme inhibitors (ACEI),angiotensin-receptor antagonists (ARB),calcium antagonists,diuretics,traditional Chinese materia medica(TCMM),and traditional antihypertensive drug compounds. The general data of the patients,such as blood pressure grade,age,sex,etc,and the administration of different types of antihypertensive drugs were compared among 3 groups. Results In the 3 groups,there were more female hypertension patients than male ones (53.77% vs 46.33%,P<0.01). There were more patients with grade Ⅲ hypertension in cardiovascular group than in non-cardiovascular group and non-internal medicine group(P<0.01). The mean other than TCMM drug cost per visit was the highest (RMB 296.75 yuan),and the mean TCMM cost per visit was the lowest (RMB 0.00 yuan) in cardiovascular group. In non-internal medicine group,the mean TCMM cost per visit was higher than the mean other than TCMM drug cost per visit(P<0.01). The first 3 most commonly prescribed drugs were calcium antagonist,β receptor blockers,and ACEI sequentially in non-cardiovascular and non-internal medicine groups,vs β receptor blockers,calcium antagonists,and diuretics sequentially in cardiovascular group. Conclusion The cardiovascular physicians generally prescribe antihypertensive drugs according to the guide. The TCMM is less used in cardiovascular group than in other two groups. Currently,in Fuxing Hospital,β receptor blockers are the first choice among all antihypertensive drugs.

Abstract:Objective To investigate the effect of gastrointestinal administration of hemin on oxidative stress in rat model of heart failure induced by pressure-overload. Methods Sixty-three adult male Sprague-Dawley rats were divided into control group (group C),heart failure group (HF group) and hemin group (Hm group) randomly,with 21 in each group. Each group was further divided into three subgroups (n=7) for the time of 4 weeks,8 weeks and 12 weeks after heart failure established. The rats in HF and Hm groups were subjected to surgical abdominal aorta constriction,while rats in control group to sham operation. At 3 weeks after surgery,rats in Hm group received daily gastric administration of hemin (60 mg/kg),while rats in HF and control groups received equal volume of normal saline. At each time points,the plasma levels of heme oxygenase-1 (HO-1),carboxyhemoglobin(COHb),malondialdehyde (MDA),oxidized low density lipoprotein (ox-LDL),and the activity of superoxide dismutase(SOD) were detected. Results (1) Compared with HF group,the plasma levels of HO-1 and COHb in Hm group were obviously increased at each time points HO-1: (6.80±0.92) μg/L vs (2.50±0.22) μg/L;(10.70±0.69) μg/L vs (4.50±0.28) μg/L;and (13.30±0.99) μg/L vs (6.07±0.71) μg/L,P<0.01; COHb: (4.34±0.31)% vs (1.68±0.11)%;(6.32±0.44)% vs (2.46±0.20) %;and (7.80±0.39)% vs (3.01±0.42)%,P<0.01. (2) Compared with HF group,the MDA levels were obviously decreased in Hm group at each time points (8.3±1.3) μmol/L vs (14.2±2.3) μmol/L,P<0.05;(9.6±0.5) μmol/L vs (20.2±3.2) μmol/L,P<0.01;and (11.8±1.1) μmol/L vs (26.0±3.7) μmol/L,P<0.01. (3) SOD activity was higher in Hm group than in HF group at each time points (125±6) kU/L vs (95±10) kU/L,P<0.01;(109±9) kU/L vs (67±5) kU/L,P<0.01;and (72±10) kU/L vs (40±6) kU/L,P<0.01. (4)The content of ox-LDL was lower in Hm group than in HF group at each time points (1.14±0.16) μmol/L vs (1.80±0.22) μmol/L,(1.38±0.14) μmol/L vs (2.34±0.25) μmol/L,and (1.83±0.16) μmol/L vs (3.17±0.31) μmol/L,P<0.01. Conclusion Production of HO-1 can be induced by gastrointestinal administration of hemin. The induction of HO-1/CO-bilirubin system may correct the in vivo unbalance of oxidation/antioxidation in HF rat induced by pressure-overload.?更多

Abstract:患者男性,51岁,主因"发作性胸背部疼痛伴呼吸困难5 d"于2008年12月23日急诊入院.2008年12月18日解大便时出现右下肢剧烈疼痛并伴有活动障碍,2 h后右下肢疼痛和无力缓解,但出现胸背部剧痛,吸气时加重,并伴呼吸困难,出汗,无反射痛,无心悸,无恶心呕吐.……