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1 病例介绍 病例1 叶毛毛男,出生2小时,住院号159623。面色青紫1.5小时入院。患儿系G_1P_1孕34周,因低置胎盘出血行剖宫产,出生评分8分,查体:早产儿貌,反应差,哭声低,时有呻吟,口吐白沫,全身紫绀明显,前囟干,呼吸64次/分,浅表,时有双吸气,两肺未闻罗音,心率118次/分,律齐,心音略低,腹平软。入院诊断:新生儿呼吸窘迫综合征,早产儿。实验室检查:血常规:Hb167G/L,WBC15.5×10~y、N74％,L36％。尿常规:PRO~+,RBC+,WBC+,大便为胎粪、血电解质:Na~+139.2mmol/L,k~+4.17mmol/L,C1~-107mmol/L,Ca~(++)2.1mmol/L,CO_2—CP18mmol/L,血培养阴性。入院后予置暖箱保养,头罩吸氧,静脉予地塞米松,5％碳酸氢钠及抗炎等治疗,入院第2天气促缓解,至生后72小时,气促又加剧,且出现腹胀,并进行性加剧,腹壁静脉显露,肠鸣音消失,考虑坏死性小肠结肠炎于入院第4天摄腹部平片,提示气腹。经外科会诊后予剖腹探查,术中见胃穿孔,部位在胃前壁近贲门处,破裂口不整
1 Case Description Case 1 leaf plump male, born 2 hours, hospital number 159623. Looking purple 1.5 hours admission. Children with G_1P_1 34 weeks of gestation, cesarean section due to low placement of placental hemorrhage, the birth rate of 8 points, physical examination: appearance of premature children, poor response, crying low, when moan, foaming at the mouth, systemic cyanosis, Before the skull, breathing 64 beats / min, superficial, when there are double inhalation, two lungs did not hear rales, heart rate 118 beats / min, law Qi, heart sounds slightly lower, abdominal soft. Admission diagnosis: neonatal respiratory distress syndrome, premature children. Laboratory tests: blood: Hb167G / L, WBC15.5 × 10 ~ y, N74%, L36%. Urine routine: PRO ~ +, RBC +, WBC +, stool meconium, blood electrolytes: Na ~ + 139.2mmol / L, k ~ + 4.17mmol / L, C1 ~ -107mmol / L, Ca ~ / L, CO_2-CP18mmol / L, blood culture negative. Admission after the warm box maintenance, hood oxygen, intravenous dexamethasone, 5% sodium bicarbonate and anti-inflammatory treatment, admitted to the first two days of gas to relieve, to 72 hours after birth, shortness of breath and aggravate, and there Abdominal distension, and progressive increase in abdominal veins revealed, bowel sounds disappear, consider necrotizing enterocolitis on the 4th day of admission to take abdominal plain film, suggesting pneumoperitoneum. After the surgical consultation to the laparotomy, intraoperative gastric perforation, the site near the cardia in the anterior wall of the stomach, rupture of the mouth is not complete