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例1.患者女性,44岁。口渴,烦躁,呕吐2天,继发腹痛,神志不清一天入院。2天前受凉后感全身疲乏无力、烦燥、口渴、继而出现恶心呕吐,经当地卫生院补液等治疗,症状不见好转,且出现剧烈腹痛,神志不清,转我院。既往健康,否认糖尿病史。检:T 37℃,PI 26次/分,R 40次/分,BP 12/9kPa,神志不清,呈昏睡状。呼吸深而急促,心肺昕诊无异常,腹部平坦,无肠形、肠蠕动波,腹肌特别紧,满腹均有压痛,尤以右上腹为甚,但无反跳痛。叩诊无移动性浊音,肝浊音界正常,听诊肠呜音活跃,腹穿(一)。B超诊断:胆囊结石。化验:Hb 12.0g/L,RBC 4.5×10~(12)/L,WBC33.6×10~9/L,N 0.83,L 0.17,CO_2 CP 12.1mmol/L。入院诊断:胆囊结石并胆囊炎,中毒性休克。经纠正酸中毒,补液及抗感染等治疗,血压略有上升,即在连续硬膜外麻醉下行胆囊切除术。术中见:胆囊大小、形态及色泽均正常,胆囊内有胆固醇结石4枚,大的蚕豆
Example 1. Female patient, 44 years old. Thirst, irritability, vomiting for 2 days, secondary to abdominal pain, unconsciousness one day admission. Feeling cold and feeling tired and tired, irritable, thirsty and then nausea and vomiting 2 days ago, the symptoms did not improve due to the local hospital rehydration treatment, and severe abdominal pain and confusion were found in our hospital. Past health, deny the history of diabetes. Check: T 37 ℃, PI 26 beats / min, R 40 beats / min, BP 12 / 9kPa, unconscious, was drowsy. Breathing deep and rapid, cardiorespiratory Xinzheng no abnormalities, flat abdomen, no bowel, gut motility wave, abdominal muscles are particularly tight, full belly tenderness, especially right upper abdomen is even more, but no rebound tenderness. Percussion non-moving dullness, normal liver dullness, auscultatory bowel sounds active, abdominal wear (a). B-diagnosis: gallstones. Assay: Hb 12.0g / L, RBC 4.5 × 10-12 / L, WBC33.6 × 10-9 / L, N 0.83, L 0.17, CO 2 CP 12.1mmol / L. Admission diagnosis: gallstones and cholecystitis, toxic shock. After correction of acidosis, rehydration and anti-infective treatment, blood pressure rose slightly, that is under continuous epidural anesthesia for cholecystectomy. See surgery: gallbladder size, shape and color are normal, there are 4 gallbladder stones, large beans