患女,54岁。因间断呕血黑便24h,不会说话12h入院。病人24h前进凉餐后自觉上腹部不适,隐痛,恶心,呕吐咖啡色胃内容物约500ml,24h内间断呕吐咖啡色胃内容物6次,每次量约300～500ml,排柏油样便2次,每次量约80g。自觉头昏,眼花,心慌,乏力,口渴,周身出冷汗。呕血12h后虽神志清楚,但失语。既往有间歇性上腹痛、反酸病史4年。查体:P 128次/min,Bp10.7/8.00kPa。重度贫血貌,皮肤潮湿,四肢末梢发凉,眼结膜、口唇、指甲苍白、心率128次/min,律齐,无杂音,上腹部有压痛,无反跳痛,肝脾未及。神志清楚。能理解医生的言语,执行命令,不能说话。眼底检查见视网膜动脉显著硬化。四肢肌力5级。生理反射存在,病 Female, 54 years old. Intermittent hematemesis black 24h, will not speak 12h admission. Patients 24h forward after the meal consciously abdominal discomfort, pain, nausea, vomiting, brown stomach content of about 500ml, 24 hours intermittent vomiting brown stomach content 6 times, each about 300 ~ 500ml, Pai Pao like 2 times, each The amount of about 80g. Conscious dizziness, dazzled, palpitation, fatigue, thirst, sweating all over the body. After vomiting 12h though conscious, but aphasia. Previously intermittent upper abdominal pain, history of acid reflux 4 years. Physical examination: P 128 times / min, Bp10.7 / 8.00 kPa. Severe anemia, wet skin, extremities cold, conjunctival, lips, nails pale, heart rate 128 beats / min, law Qi, no noise, tenderness on the abdomen, no rebound pain, liver and spleen not yet. Consciousness. Can understand the doctor’s speech, the implementation of orders, can not speak. Fundus examination revealed severe retinal artery sclerosis. Limb muscle strength 5. Physiological reflex exists, disease