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患者,男,38岁.病案号281375.1985年经肝穿刺活检诊断为慢性活动性肝炎,1990年诊断为肝炎肝硬化.此次因呕血、柏油样大便于1993年4月13日入院.检查:血压13.3/9.3 kPa,中度贫血貌,皮肤巩膜无黄染,心尖区闻及Ⅱ级收缩期吹风样杂音,腹部软,肝脏右肋下未扪及,脾脏左助下2.5cm,移动性浊音阳性,腹水外观无色透明,诊断为“食管胃底静脉破裂出血”.入院后患者呕血、便血多次,总量约4000ml.先后给予输血2400ml,应用止血敏1.0g,止血芳酸0.6g,每天1次静脉滴入;止血敏、安络血肌肉注射,脑垂体后叶素持续静脉点滴,后经三腔双囊管压迫止血、出血量逐渐减少.入院后第9天患者自诉左上腹部刀割样疼痛,阵发性加剧,伴腹胀,无恶心呕吐,无排气排便.查体:腹部膨隆,未见肠型及蠕动波,左上腹部局限性压
Patient, male, 38 years old. Case No. 281375. Diagnosed as chronic active hepatitis by a liver biopsy in 1985 and diagnosed with hepatitis cirrhosis in 1990. The vomiting was followed by asphaltic stool admission on April 13, 1993. Examination: Blood pressure 13.3 / 9.3 kPa, moderate anemia appearance, no yellow scleral skin atrophy, apical zone smell and Ⅱ grade systolic hair-like murmurs, abdominal soft, no palpable right rib in the liver, spleen left apex 2.5cm, mobility dullness positive , The appearance of ascites colorless and transparent, diagnosed as “esophageal variceal bleeding.” After admission, patients vomiting blood, blood in the stool several times, a total of about 4000ml. Has given blood transfusions 2400ml, application of hemostatic sensitivity 1.0g, hemostatic aromatic acid 0.6g, 1 intravenous infusion; hemostatic sensitivity, safety collateral blood intramuscular injection of pituitrin continuous intravenous drip, after three-chamber double cystic duct compression hemostasis, bleeding decreased gradually.Pat 9 days after admission, the patient sued the upper left abdominal knife Like pain, paroxysmal aggravating, with abdominal distension, no nausea and vomiting, no exhaust bowel movements. Physical examination: abdominal bulge, no intestinal and peristaltic waves, localized upper left abdominal pressure