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患男,28h。以面色苍白16h代主诉入院。系1胎1产,足月顺产,生后轻度窒息,4h排胎粪,量多,6h排尿,未哺乳。16h前开始面色苍白,进行性加重,伴呻吟,呕吐4次,呈非喷射状,吐物为淡红色粘液,每次量约5～10ml不等,呼吸困难,肢体发凉,尿量少,排胎粪1次,量少。查体:T31℃,R100次/min,体重2.9kg,BP6.6/3.9kPa,发育正常,营养良好,神志清,反应极差,呻吟不止,面色、皮肤粘膜明显苍白,毛细血管充盈时间>4s,下腹壁可见针尖大小出血点,皮肤无黄染,头颅无畸形,前囟0.5cm×0.5cm,紧张,颈软,双肺呼吸音粗糙,心音低钝,心率81次/min,心律不齐,可闻及早搏20次/min,未闻及杂音,腹部稍膨隆,未见肠型及蠕动波,腹肌稍紧张,肝脏肋下3cm,剑下4cm,质软,脾未触及,腹部未扪及包块,腹水征阳性,肠鸣音减弱,脐带未脱落,脐部无渗出。四肢肌张力减低,原始反射未引出。入院后腹腔穿刺呈血性腹水,放置不凝固。考虑急腹症脏器破裂出血可能性大,患儿处于休克状态,不能进行剖腹探查,立即给予扩容,急输血纠正休克,以及对症治疗等,抢救20h无效死亡。尸体解剖,腹腔内暗红色血约40ml,肝脾无异常,冒十二指肠、结肠无
Suffering from men, 28h. The pale 16h on behalf of the main hospital admission. Department of 1 child 1 birth, full-term follow-up, mild suffocation after birth, 4h row of meconium, amount, 6h urination, not breast-feeding. 16h before pale, progressive aggravating, with groaning, vomiting 4 times, was non-jet-like, spit into the light red mucus, each volume of about 5 ~ 10ml, dyspnea, cold limbs, less urine, row Meconium 1 times, less. Physical examination: T31 ℃, R100 times / min, weight 2.9kg, BP6.6 / 3.9kPa, normal development, good nutrition, conscientious, poor response, moaning more than looking, pale skin mucosa, capillary filling time> 4s, the lower abdominal wall can be seen the size of the tip of the bleeding point, the skin without yellow dye, head deformity, anterior fontanel 0.5cm × 0.5cm, tension, neck soft, rough lung sounds, blunt heart sound, heart rate 81 beats / min, Qi, can be heard and premature beats 20 times / min, no smell and noise, the abdomen slightly bulging, no intestinal and peristaltic waves, a little nervous abdominal muscles, liver rib 3cm, sword 4cm, soft, spleen not touched, abdomen Not palpable mass, positive signs of ascites, bowel sounds weakened, umbilical cord did not fall off, umbilical no leakage. Limb muscle tension decreased, the original reflection did not lead. Admission abdominal paracentesis was bloody ascites, placed not coagulation. Consider the possibility of acute abdomen organ rupture bleeding, children in shock state, can not be laparotomy, immediately given dilatation, acute blood transfusion to correct shock, and symptomatic treatment, rescue 20h invalid death. The autopsy, intraabdominal dark red blood about 40ml, no abnormal liver and spleen, the risk of duodenum, colon