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患女,18岁。以头痛、呕吐伴神志不清1h入院。3d前因染发受凉后发热、头闷痛,无呕吐,按“感冒”对症治疗后体温降至正常。入院前1h在上课时觉头痛并呕吐1次,30min后出现神志不清,被学校急送医院以散发性脑炎收住院。查体:T36.8℃,P72次/min,R22次/min,BP8/6kPa。神志不清,处于浅昏迷状态,四肢冰凉、口唇发绀,双侧颈静脉不怒张,双肺(-),心界不大,心率72次/min,节律不齐,可闻及偶发早搏,心音低钝,各瓣膜听诊区未闻及病理性杂音。腹部(-)。神经系统除呈浅昏迷状态外未查到任何阳性体征。血常规:WBC 9.6×10~9/L,RBC 4.56×10~(12)L,肾功正常,脑电图未发现明显异常。给抗休克治疗,血压长时间不回升,急查心电图提示:V_1～V_5导联QRS波群呈QS型,S—T段抬高0.4～0.7mV,T波直立,并呈Ⅱ~0房室传导阻滞,偶发室性早搏。
Women, 18 years old. To headache, vomiting with delirium 1h admission. 3d hair dye due to fever, headache, nausea, vomiting, press “cold” symptomatic treatment after the temperature dropped to normal. 1h before admission, headache and vomiting in class 1, 30min after the confusion, the school was sent to the hospital to send encephalitis admitted to hospital. Physical examination: T36.8 ℃, P72 times / min, R22 times / min, BP8 / 6kPa. Unconscious, in a shallow coma state, cold limbs, lips cyanosis, bilateral jugular vein does not anger Zhang, lung (-), heart, heart rate 72 beats / min, irregular rhythm can be heard and premature beats, Low heart sound blunt, the valve auscultation area did not smell and pathological murmur. abdomen(-). In addition to the nervous system was shallow unconscious state did not find any positive signs. Blood: WBC 9.6 × 10 ~ 9 / L, RBC 4.56 × 10 ~ (12) L, normal renal function, EEG was not found significant abnormalities. To anti-shock treatment, blood pressure does not rise for a long time, acute ECG prompted: V_1 ~ V_5 lead QRS complex was QS type, S-T segment elevation of 0.4 ~ 0.7mV, T wave upright, and was Ⅱ ~ 0 atrioventricular Blocking, occasional ventricular premature beats.