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患者 男性,40岁,农民.主因:食欲下降1个月,黑便2天,发热1天来院.1个月前上腹饱胀,食欲明显下降,体重明显减轻(1个月下降10公斤),同时有乏力,病后20余天突然黑便、血压下降、面色苍白,住当地县医院.经输血、输液、止血等治疗出血停止.住院期间曾有高热1次,体温达40℃以上,按输液反应处理1天体温下降至正常.但患者一般情况差,面色苍白、大汗、四肢冷凉,血压偏低转来我院.既往有慢性上腹痛史.查体:T36.5℃,P 64次/分,R 18次/分,BP 13/8kPa(95/60mmHg).消瘦、表情淡漠、大汗、面色苍白,双下肢皮肤粗糙脱屑.双颌下、腋下及右上肢前臂内侧可触及数个肿大淋巴结.结膜苍白,巩膜无黄染.两肺未见异常,心率64次/分,心音低,十二指肠区有局限性压痛.肝未触及,脾肋下1.5cm,质软.腹部无移动性浊音.入院诊断:上消化道出血.原因:①消化性溃疡;②胃癌?给予输液、洛赛克口服.于入院第2天突然高热、大汗淋漓、胸闷、发绀,遂排柏油样大便约500g,体温41℃,血压9/4kPa(70/30mmHg),心率120次/分,四肢厥冷,甲床发绀.当时考虑输液反应,失血性休克.经治疗1天病情平稳,血压正常,但出现右上腹和右下腹肌张力增高,有压痛反跳痛,很快波及全腹.肝浊音界存在,脾增至肋下3cm.胸腹联透:膈下少量游离气体,腹腔抽出黄色液体约3ml.镜检:红?
Main reasons: appetite decreased by 1 month, black stool 2 days, 1 day fever to the hospital .1 months ago, abdominal fullness, appetite decreased significantly, weight was significantly reduced (1 month down 10 kg) , At the same time there are weakness, suddenly more than 20 days after the illness black, blood pressure, pale, living in the county hospital .Transfusion, infusion, bleeding and other bleeding stopped .He had fever during hospitalization, body temperature of 40 ℃ above, press Infusion reaction treatment 1 day body temperature dropped to normal.But patients generally poor, pale, sweat, cold limbs, low blood pressure transferred to our hospital .Previous history of chronic upper abdominal pain. Physical examination: T36.5 ℃, P 64 beats / min, R 18 beats / min, BP 13 / 8kPa (95 / 60mmHg) .Small skin, apathetic, sweat, pale, rough skin on both lower extremities.Double submandibular, Can reach several swollen lymph nodes .Conjunctiva pale, scleral no yellow dye .No abnormal lungs, heart rate 64 beats / min, low heart sound, limited duodenal tenderness .Liver not touched, spleen rib 1.5cm , Soft, abdominal dullness without mobility Admission diagnosis: upper gastrointestinal bleeding Cause: ① peptic ulcer; ② gastric cancer? Give infusion, oral Losec in Day 2 of the hospital suddenly high fever, sweating, chest tightness, cyanosis, then row asphalt like stool about 500g, body temperature 41 ℃, blood pressure 9 / 4kPa (70 / 30mmHg), heart rate 120 beats / min, extremities Jueleng, At that time, consider the infusion reaction, hemorrhagic shock .After 1 days of treatment was stable, normal blood pressure, but there is the right upper quadrant and right lower quadrant muscle tension increased tenderness rebound pain, soon spread to the whole abdomen. To the ribs 3cm. Thoracoabdominal: a small amount of free gas under the diaphragm, the abdominal cavity to extract the yellow liquid about 3ml. Microscopic examination: red?