中英文病例：毛细血管搏动征

本病例摘自2013年8月17日《新英格兰医学杂志》

毛细血管搏动征（capillary pulsation syndrome），又称Quincke征，用手指轻压患者指床末端或以清洁的玻璃片轻压其口唇黏膜如见到红白交替的节律性微血管搏动现象称为毛细血管搏动征。主动脉关闭不全时可见到这一现象，其他脉压增大的疾病，如重症贫血、甲状腺功能亢进症等，亦可出现毛细血管搏动现象。

Quincke's Pulse

A 34-year-old man presented with a 6-to-8-week history of fatigue, malaise, fevers, and night sweats. He had a history of a congenital quadricuspid aortic valve and 16 years earlier had undergone a Ross procedure (during which the aortic valve was replaced by a pulmonary autograft and the pulmonary valve was replaced by a pulmonary homograft). On examination, the temperature was 39.2°C and the blood pressure 130/50 mm Hg. A grade 3/4 diastolic murmur was heard over the base of the heart. Alternating flushing and blanching of the nail beds of several fingers in concert with the cardiac cycle, known as Quincke's pulse, was easily visualized (see video). Transthoracic echocardiography confirmed severe insufficiency of the pulmonary autograft and homograft in association with vegetations. Blood cultures grew Streptococcus milleri. The patient underwent replacement of both grafts. Quincke's pulse is a physical finding of severe and chronic aortic insufficiency. Regurgitant blood flow into a dilated left ventricle during diastole leads to a decrease in diastolic pressure and a consequent increase in stroke volume, resulting in blanching and flushing, respectively, of the nail bed.

34岁男，出现疲倦、精神萎靡、发热和盗汗等症状6~8周。病史包括先天性四叶主动脉瓣，Ross术后16年（Ross术：病变的主动脉瓣被病人自身健康的肺动脉瓣取代，随后用来自供体的瓣膜取代肺动脉瓣）。查体：T 39.2°C，BP 130/50 mm Hg。心底部听诊闻及3/4级舒张期杂音。可见典型的Quincke征（毛细血管搏动征），即病人甲床出现与心动周期相对应的节律性红白交替现象。请观看下面的视频，大小约800kb。经胸壁超声心动图证实自体和异体肺动脉瓣均出现赘生物导致的严重功能不全。血培养证实米勒链球菌阳性。随后，病人的两个瓣膜均被替换。毛细血管搏动征是严重和慢性主动脉瓣功能不全的体征。舒张期时左心室扩张，如果此时血液返流，则舒张压下降及每搏输出量增加，导致甲床出现红白相间的节律性交替现象。