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患者,女性,64岁。因头痛伴畏寒发热6小时,神志不清1小时,于1992年11月20日入本院诊治。入院检查:浅昏迷,T38℃,BP25/14kPa,两侧瞳孔等大等圆,直径2mm 大小,颈软无抵抗,心率64次/分,律齐,未闻及杂音,腹部无压痛及反跳痛。肝脾肋下未及;四肢肌张力减弱,未引出病理反射,脑膜刺激征(-)。眼底检查视神经乳头轻度水肿,无出血。WBC12.4×10~9/L,N0.80,L0.20。初步诊断昏迷待查(脑溢血可能)。即予20%甘露醇脱水及利血平降血压等治疗,但于入院4小时后患者出现喷射性呕吐2次,呕吐物为咖啡色样液体,总量约2000ml,并出现不规则呼吸,检查发现两侧瞳孔不等大,右侧5mm,左侧2mm,BP 为27/12kPa,左侧肢体瘫痪,巴彬基氏征(+)。诊断脑疝并发上消化道出血。立即加强脱水及输血止血等治疗,经积极治疗
Patient, female, 64 years old. Due to headache with chills and fever for 6 hours, confusion 1 hour, on November 20, 1992 into our hospital for diagnosis and treatment. Admission examination: shallow coma, T38 ℃, BP25 / 14kPa, both sides of the pupil and other large round, diameter 2mm size, neck soft non-resistance, heart rate 64 beats / min, law Qi, no smell and noise, abdomen no tenderness and rebound pain. Liver and spleen subequal; limb muscle tone decreased, did not lead to pathological reflex, meningeal irritation (-). Fundus examination optic nerve head mild edema, no bleeding. WBC12.4 × 10 ~ 9 / L, N0.80, L0.20. Preliminary diagnosis coma pending (stroke may be). That is to 20% mannitol dehydration and hypotensive blood pressure and other treatment, but 4 hours after admission in patients with jet vomiting 2 times, vomit brown liquid, total about 2000ml, and irregular breathing, examination found that Pupils on both sides of the large, right 5mm, left 2mm, BP was 27 / 12kPa, left limb paralysis, Palinkey’s sign (+). Diagnosis of hernia complicated by upper gastrointestinal bleeding. Immediately strengthen the dehydration and blood transfusion and other treatment, the active treatment