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患者男,59岁,干部。入院前4天上午11时突起恶心,随后呕吐1次暗红色血液,量约200毫升。解黑便4次,总量约600毫升,伴头晕,在家休息。入院半小时前仍解黑便2次,量约500毫升,并渐昏睡而急送我院。查体:体温、脉搏、血压测不出。昏睡状态,全身冷汗,重度贫血貌。心音低钝,肺无罗音,腹平坦,柔软,肝脾未触及。血红蛋白30g/L,红细胞为0.98×10~(12)/L。诊断为胃出血。经给含钠晶体液补充血容量、止血、吸氧、纠正酸中毒及电解质紊乱,至中午未见出血,神志渐清,但一般情况仍差。输血中患者突然烦躁不安,随即昏睡,并渐昏迷。心肺(一),左鼻唇沟浅,口角向右斜,咽反射消失,右侧肢体肌力0级,右巴氏征阳性。血胆固醇141毫克%,脑脊液蛋白7.55毫克%,糖45毫克%,细胞数0。考虑脑
Male patient, 59 years old, cadre. 4 days before admission at 11 am sudden nausea, then vomit a dark red blood, the amount of about 200 ml. Solutions to the black 4 times, a total of about 600 ml, with dizziness, rest at home. Half an hour before admission still black solution 2 times, about 500 ml, and gradually lethargic and urgently sent to our hospital. Physical examination: body temperature, pulse, blood pressure can not be measured. Lethargic state, body cold sweat, severe anemia appearance. Low heart sound blunt, lungs without rales, flat belly, soft, liver and spleen not touched. Hemoglobin 30g / L, red blood cells 0.98 × 10 ~ (12) / L. Diagnosis of stomach bleeding. After giving sodium crystalloid fluid volume, bleeding, oxygen, correct acidosis and electrolyte imbalance, no bleeding at noon, consciousness gradually clear, but the general situation is still poor. Blood transfusions in patients with sudden irritability, then lethargic, and gradually coma. Cardiopulmonary (A), the left nasolabial fold shallow, right angle diagonal mouth, pharyngeal reflex disappeared, the right limb muscle 0, positive right Bashang sign. Blood cholesterol 141 mg%, cerebrospinal fluid protein 7.55 mg%, sugar 45 mg%, number of cells 0. Think about the brain