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患者,男,34岁。下腹部被汽车撞伤4小时而急诊入院。体检:神志清楚,失血貌。BP13/8kPa,HR96次/分。心、肺(-)。腹部轻度肌紧张,全腹均有轻度压痛及反跳痛,下腹部较著。肝、脾肋下未触及,移动性浊音(+),肠鸣音活跃。双肾区(-),膀胱不充盈,有压痛。骨盆分离试验(+)。左下肢肌力Ⅱ级,感觉存在。神经系(-)。实验室检查:Hb100g/L,WBC12.6×10~9/L,N88%。X线检查提示左骶髂关节粉碎性骨折,左耻骨支骨折。B超示腹腔内中等量积液,脾包膜下血肿,肝、胆、胰、双肾未见明显异常。左下腹穿刺抽出3ml淡血性液体,不凝固。入院诊断:①内脏破裂,②骨盆骨折。
Patient, male, 34 years old. Lower abdomen was hit by a car 4 hours and emergency admission. Physical examination: conscious, blood loss appearance. BP13 / 8kPa, HR96 beats / min. Heart, lung (-). Abdominal mild muscle tension, mild abdominal tenderness and rebound tenderness, lower abdomen significantly. Liver, spleen ribs untouched, shifting dullness (+), bowel sounds active. Kidney area (-), the bladder is not full, tenderness. Pelvic separation test (+). Left lower limb muscle strength Ⅱ, feeling there. Nervous system (-). Laboratory tests: Hb100g / L, WBC12.6 × 10 ~ 9 / L, N88%. X-ray examination prompted comminuted fracture of the left sacral iliac joint, left pubis fracture. B ultrasound showed moderate volume of intraperitoneal effusion, splenic capsule hematoma, liver, gallbladder, pancreas, kidneys no obvious abnormalities. Left lower quadrant puncture extract 3ml pale bloody liquid, no coagulation. Admission diagnosis: ① visceral rupture, ② pelvic fracture.