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病历摘要刘某,30岁,农民,住院号305577。因产后9天,无尿。呼吸困难伴全身水肿3天,于1987年1月15日由某县医院转来。9天前,患者因40周妊娠G_2P_1,LOA,产前子痫,入某县医院。入院后突然阴道大流血达1500ml 以上。血压测不到,胎心音消失,诊为胎盘早剥行剖宫产术,取出一男死婴。手术证实胎盘早剥,子宫卒中,宫缩乏力,出血较多,故行子宫次全切除术。手术日及术后1～9天出入水量情况见表1。查体:急性病容,端坐呼吸,烦躁不安。Bp180/110mmHg,P130次/分,T36.5℃。眼结膜明显水肿,口辰紫绀,全身水肿。心音低钝、律整,各瓣膜区未闻及杂音。双肺满布小水泡音。腹部膨隆,腹水征(+),腹部切口裂开,有大量渗液,下腹部有压痛反跳痛,双下肢高度凹陷性水肿。病理反射未引出。眼底所见:视网膜高度水肿,呈高血压视网膜症Ⅱ°。实验室检查:血红蛋白68g/L,红细胞2.45×10~(12)/L,白细胞14.2×10~9/L,中性94%,血小板260×10~9/L。出凝血时间正常,凝血酶时间正常,三P 试
Medical record summary Liu, 30 years old, farmer, hospital number 305577. 9 days after childbirth, no urine. Dyspnea with systemic edema for 3 days, on January 15, 1987 transferred from a county hospital. 9 days ago, patients due to 40 weeks of pregnancy G_2P_1, LOA, prenatal eclampsia, into a county hospital. After admission sudden vaginal bleeding up to 1500ml above. Can not be measured blood pressure, fetal heart sound disappeared, diagnosed as placental abruption cesarean section, remove a male infant. Surgery confirmed placental abruption, uterine stroke, uterine inertia, bleeding more, so the line subtotal hysterectomy. Surgery day and postoperative 1 to 9 days access to water conditions shown in Table 1. Physical examination: acute illness, sitting and breathing, irritability. Bp180 / 110mmHg, P130 times / min, T36.5 ℃. Conjunctival obvious edema, oral cyanosis, systemic edema. Low heart sound blunt, law, the valve area did not smell and noise. Double lung covered with small blisters sound. Abdominal bulging, signs of ascites (+), abdominal incision rupture, a lot of exudate, tenderness under the abdomen reflex pain, both lower extremity highly pitting edema. Pathological reflex did not lead. Fundus seen: a high degree of retinal edema, hypertensive retinopathy was Ⅱ °. Laboratory tests: hemoglobin 68g / L, red blood cells 2.45 × 10-12 / L, white blood cells 14.2 × 10 ~ 9 / L, 94% neutral, platelets 260 × 10 ~ 9 / L. A normal clotting time, normal thrombin time, three P test