论文部分内容阅读
患者邱××,33岁,住院号3321。因足月临产2小时,胎儿躯体娩出,后出头困难,于1965年6月17日19点入院。预产期1965年6月中旬,孕期无特殊。入院当日17点钟有宫缩,18点钟30分左右胎儿躯体娩出,头娩出困难,遂来急诊。过去四胎皆足月顺产,末次于两年前。检查:急性痛苦面容,血压140/100毫米汞柱,体温37.2℃,脉搏84次/1分,呼吸24次/1分。心肺无異常,肝脾未触及,上腹软。子宫体已收缩成球形,略偏右侧,子宫下段因儿头未下,过分扩张并有压痛。阴道内脱出胎儿躯体,臍带已停止搏动,脊椎有裂孔。于20点30分左右以穿顱术结束分娩,胎盘完整,当时流血约300-400毫升,肌注脑垂体后叶10单位、麦角新硷0.5毫克,宫缩好,术后未作子宫探查,一般情况尚好。次日晨,患者诉恶心、呕吐、腹胀、作闷。血压140/90毫米汞柱,体温37.2℃,脉搏88次/1分,呼吸24次/1分。现轻度贫血,腹胀,宫底平臍,收缩好,整个下腹部有明显的压痛和反跳痛,以右下腹为甚,并于臍下触知握雪音,疑子宫破裂,经子宫探查确诊。血常规:血色蛋白7克,红细胞310万,白细胞6800,中性74％,淋巴21％,酸性3％,单核2％。下午在醚麻下行子宫修补术,术中发现:腹腔有血性液体约300毫升,子宫体光滑,子宫下段浆膜完
Patient Qiu × ×, 33 years old, hospital number 3321. Due to full-term labor for 2 hours, the fetus was delivered, after the first difficulties, at 19:00 on June 17, 1965 admission. The expected date of birth in mid-June 1965, no special pregnancy. 17 o’clock on the day of admission with contractions, around 18 o’clock fetal body was delivered around 30, the first delivery of difficulties, then emergency. The past four fetuses all have full-term follow-up, the last two years ago. Check: acute painful face, blood pressure 140/100 mm Hg, body temperature 37.2 ℃, pulse 84 times / 1 minute, breathing 24 times / 1 minute. No abnormal heart and lung, liver and spleen not touched, upper abdomen soft. The uterus has been reduced to a spherical body, slightly to the right, the lower uterine segment due to child head, over-expansion and tenderness. Vaginal prolapse fetal body, the umbilical cord has stopped beating, spine has a hole. At around 20:30 to wear craniotomy end of childbirth, placental integrity, then bleeding about 300-400 ml, intramuscular injection of 10 units after the pituitary gland, ergot 0.5 mg, contractions good, uterine exploration after surgery, The general situation is good. The next morning, the patient sued nausea, vomiting, abdominal distension, boring. Blood pressure 140/90 mm Hg, body temperature 37.2 ℃, pulse 88 times / 1 minute, breathing 24 times / 1 minute. Now mild anemia, abdominal distension, Palace umbilical flat, good contraction, the entire lower abdomen had significant tenderness and rebound tenderness, to the right lower abdomen and even touch the snow under the touch of the umbilical, suspected uterine rupture, the uterus exploration Confirmed. Blood: 7 grams of hemoglobin, erythrocyte 3.1 million, white blood cells 6800, 74% neutral, lymphatic 21%, acidic 3%, mononuclear 2%. Uterine anesthesia in the afternoon under the ether anesthesia, intraoperative findings: about 300 ml of intraperitoneal bloody fluid, uterine body is smooth, the end of the lower uterine serosa