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患者,女,17岁,住院号274704。因腹胀、纳差,乏力三月入院。无肝炎病史。入院体检;全身无黄染及蜘蛛痣。心肺无异常。腹软,肝右肋下1cm,质地中等,无触痛。脾肋下未及。移动性浊音(+)。乙肝免疫标记物测定(一)。胃镜示食管静脉曲张Ⅲ°。B超提示肝尾状叶增大。临床诊断Budd—chiari综合征(经下腔静脉造影及肝活硷证实)。普鲁卡因皮试(一)。术前血压14.7/9.3kPa(110/70mmHg);心率66次/分。穿刺顺利。术后即时血压16.0/10.7kPa,(120/80mmHg),心率70次/分。10分钟后自觉胸闷、气短,继之面包爸自,烦躁,大汗,四肢末稍发凉。测血压10.7/6.7kPa(80/50mmHg)。心率50次/分。立即进行诊断性腹腔穿刺,抽出5ml淡黄色清亮腹水,镜检无红细胞。2小时后血压仍为10.7/6.7kPa(80/50mmHg)。给予5％糖盐水1000ml。于45分钟内快
Patient, female, 17 years old, hospital number 274704. Due to bloating, anorexia, fatigue in March hospitalization. No history of hepatitis. Admission medical examination; body without yellow dye and spider nevus. No abnormal heart and lung. Abdomen soft, right rib 1cm, medium texture, no tenderness. Spleen under the ribs. Mobility (+). Hepatitis B immune marker determination (a). Gastroscopy showed esophageal varicosity Ⅲ °. B-Tip liver caudate lobe enlargement. Clinical diagnosis of Budd-chiari syndrome (confirmed by inferior vena cava angiography and hepatic alkaline). Procaine test (a). Preoperative blood pressure 14.7 / 9.3kPa (110 / 70mmHg); heart rate 66 beats / min. Puncture smooth. Immediate postoperative blood pressure 16.0 / 10.7kPa, (120 / 80mmHg), heart rate 70 beats / min. After 10 minutes conscious chest tightness, shortness of breath, followed by bread dad, irritability, sweating, extremities slightly cold. Blood pressure 10.7 / 6.7kPa (80 / 50mmHg). Heart rate 50 beats / min. Immediate diagnostic paracentesis, 5ml light yellow aspiration out of ascites, microscopic examination of red blood cells. Blood pressure remained at 10.7 / 6.7 kPa (80/50 mmHg) after 2 hours. Give 5% sugar water 1000ml. Quick in 45 minutes