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患者女,34岁。因腹痛、发热4 d,加重2 h 急诊入院。患者于入院前4 d 无明显诱因出现上腹部疼痛不适、寒热,自行在社区门诊静滴抗炎药物治疗(具体不详)。入院前2 h 突然出现全腹剧痛。门诊胸腹联透提示:心肺未见异常。X 线征象,双侧膈下可见新月形游离气体影。以“上消化道穿孔”收入院。入院查体:T 38.6℃,P 98次/min,BP 100/60 mmHg,神志清,皮肤黏膜无黄染。心肺(-)。腹平坦,腹肌紧张,全腹压痛、反跳痛阳性,尤以上腹部剑突下为著。肝浊音界消失,移动性浊音
Female patient, 34 years old. Due to abdominal pain, fever 4 d, increased 2 h emergency admission. Patients in the first 4 days before admission there is no obvious incentive for upper abdominal pain discomfort, cold and heat, their own community clinics intravenous anti-inflammatory drug treatment (specifically unknown). 2 h before admission suddenly appeared full abdomen pain. Outpatient chest and abdomen Tip: no abnormal heart and lungs. X-ray signs, both sides of the diaphragm visible crescent free gas shadow. To “upper gastrointestinal perforation ” income court. Admission examination: T 38.6 ℃, P 98 times / min, BP 100/60 mmHg, clear mind, no yellow skin and mucous membranes. Cardiopulmonary (-). Abdomen flat, abdominal muscle tension, full abdominal tenderness, rebound pain positive, especially in the upper abdomen xiphoid. Liver dullness disappeared, mobility dullness