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患者男性,25岁,干部。因发热6天,晕倒1次,由当地卫生队拟诊急性黄疸型肝炎而于1991年12月27日转入本院,当时无头痛、鼻塞、咳嗽,肝功能示TB68.4μmol/L,ALT87IU。体检:T、P、R、BP均正常,精神软,神志清,皮肤巩膜轻度黄染,心肺听诊正常。腹平软,剑下压之不适感,肝脏肋下2.0cm,质软明显触痛,脾脏肋下未触及,肝区叩击痛明显,腹水征(一),两下肢无凹陷性浮肿。临床诊断:急性黄疸型病毒性肝炎。入院次日下午患者出现神志模糊,定时、定向和计算力均障碍,各种检查均不能配合,即考虑“急性重型病毒性肝炎”予综合性抢救治疗。晚间患者精神症状加重,出现狂躁、吼叫、自拔输液管、踢翻输液架、挣脱手足束缚绷带,给予东莨菪碱、安定等镇静药物均不能使其安静。入院第3天(发病第8天)晨患者神志时清时糊,有时能正确对答,有时答非所问,基本能配合检查,皮肤巩膜黄染无明显加深,肝浊音界无缩小,肝仍肋下
Male patient, 25 years old, cadre. Due to fever for 6 days, fainted 1 times, the local health team to be diagnosed with acute jaundice hepatitis in December 27, 1991 transferred to the hospital, then no headache, stuffy nose, cough, liver function showed TB68.4μmol / L, ALT87IU. Physical examination: T, P, R, BP are normal, the spirit of soft, clear mind, skin scleral mild yellow dye, cardiopulmonary auscultation normal. Abdominal soft, under the sword uncomfortable feeling, ribs under the ribs 2.0cm, soft and tender tenderness, spleen rib did not touch, liver percussion pain was obvious, signs of ascites (a), two lower limbs without pitting edema. Clinical diagnosis: acute jaundice viral hepatitis. Admission on the afternoon of the next day, patients with ambiguity, timing, orientation and calculation of power disorder, a variety of tests are not compatible, that is, “acute severe viral hepatitis” to a comprehensive rescue treatment. Patients with mental symptoms worsened at night, appear manic, roar, exasperated transfusion tubes, kick the infusion rack, get rid of hand-foot bandage, give scopolamine, stability and other sedative drugs can not make it quiet. Admission the first 3 days (onset of the first 8 days) morning when the patient consciousness clear when the paste, and sometimes right answer, and sometimes non-questioning, the basic can with the examination, no significant scleral yellow sclera, liver no obstruction of the voiced sector,