论文部分内容阅读
患者男,63岁,于1992年4月2日突然出现右侧肢体瘫痪,伴头痛,无发热,在当地医院按脑梗塞治疗2天不见好转而到我院就诊,头部CT检查确诊为左侧丘脑出血,出血量约11ml.查体:体温36.4℃,脉搏78次/分,血压21.33/14.0kPa,呼吸18次/分,发育正常,营养中等,意识轻度障碍,超皮质性感觉失语,颈天抵抗,心肺正常,右侧肢体肌力Ⅱ级,克匿格征阳性,巴彬斯基征阳性,膝腱反射亢进,左侧均正常.血常规、尿常规、肝功皆正常,心电图示窦性心率,左室肥厚,心肌劳损.入院后经应用脱水剂、止血剂等对症治疗4天病情逐渐好转,于入院第5天晨间4时突然发生部位不定的剧烈腹痛,无发热,恶心不吐.患者体温36.9℃,脉搏110次/分,呼吸20次/分,血压:13.33/8.0kPa,面色苍白呈急性病容,双肺正常.心音低钝律整,心率110次/分,腹部膨隆,全腹有压痛和反跳痛,选择两侧腹部不同点试验穿刺均抽出不凝血约20ml,初诊为脑出血合并腹腔出血,即时抢救休克,并请外科会诊.尽早手术.实验室检查:红细胞50×10~(12)/L,血红蛋白130g/L,白细胞14.0×10~9/L,中性0.88,淋巴0.12,出凝血时间,血小板,尿常规,肝功均正常.
Male, 63 years old, on April 2, 1992 suddenly appeared in the right limb paralysis, with headache, no fever, in the local hospital for 2 days did not improve the treatment of cerebral infarction and went to our hospital, the head CT was diagnosed as left Hypothalamic hemorrhage, the amount of bleeding about 11ml. Examination: body temperature 36.4 ℃, pulse 78 beats / min, blood pressure 21.33 / 14.0kPa, breathing 18 beats / min, normal development, moderate nutrition, mild cognitive impairment, hypercortical aphasia , Cervical neck resistance, normal heart and lung, right limb muscle strength Ⅱ level, Kegong sign positive, Babinski sign positive, knee tendon hyperreflexia, the left are normal blood, urine, liver function are normal, ECG showed sinus heart rate, left ventricular hypertrophy, myocardial strain.After admission by the application of dehydration agents, hemostatic agents and other symptomatic treatment gradually improve the condition of 4 days in the morning of the fifth day of admission at 4 o’clock suddenly occurred in severe abdominal pain, no fever , Nausea and vomiting.Patients temperature 36.9 ℃, pulse 110 beats / min, breathing 20 beats / min, blood pressure: 13.33 / 8.0kPa, pale pale acute lesions, normal lungs. , Abdominal bulging, the whole abdomen with tenderness and rebound tenderness, abdomen on both sides of the choice of different punctures are not bleeding out of about 20ml, early As cerebral hemorrhage with intraperitoneal hemorrhage, immediate rescue shock, and surgery consultation. Early surgery. Laboratory tests: red blood cells 50 × 10-12 / L, hemoglobin 130g / L, white blood cells 14.0 × 10 ~ 9 / L, neutral 0.88, lymphatic 0.12, clotting time, platelets, urine, liver function were normal.