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患者,女,49岁,因头痛、无尿2d入内科,有高血压病史3年。查体:BP29.3/17.3kPa,精神不振,双肺呼吸音低,未闻及干湿性罗音,心率120次/min,律齐,A_2>P_2,心音有力。腹软,肾动脉区无血管杂音。急查血K~+5.64mmol/L,CO_2CP16mmol/L,Cr582μmol/L,BUN326mmol/L,血常规:WBC10.6×10~9/L,N0.81,L0.19,PLT237×10~9/L,Hb134g/L,凝血酶原时间12.3s,纤维蛋白原定量8.2g/L,B超示双肾、输尿管、膀胱无异常。诊断急性肾功能不全,高血压病Ⅲ期。立即给予静脉内插管肝素抗凝血液透析及对症治疗。至发病15d,透析第8次时出现颈内静脉插管内血栓形成,透析过程中高凝,之后又出现肉眼血尿,皮肤散在出血点,复查血常规:WBCS5.2×10~9/L,N0.59,PLT43×10~9/L,Hb89g/L,凝血酶原时间10.3s,纤维蛋白原定量5.7g/L,血小板聚集
Patients, female, 49 years old, due to headache, no urine 2d into the medical history of hypertension for 3 years. Examination: BP29.3 / 17.3kPa, lack of energy, low lung breath sounds, no smell and wet and dry rales, heart rate 120 beats / min, law Qi, A_2> P_2, heart sounds powerful. Abdominal soft, renal artery without vascular murmur. The blood levels of K +5.64mmol / L, CO_2CP16mmol / L, Cr582μmol / L, BUN326mmol / L, WBC10.6 × 10-9 / L, N0.81, L0.19, PLT237 × 10-9 / L, Hb134g / L, prothrombin time 12.3s, fibrinogen quantitative 8.2g / L, B ultrasound showed renal, ureteral, bladder no abnormalities. Diagnosis of acute renal insufficiency, hypertension stage Ⅲ. Immediate intravenous heparin anticoagulation hemodialysis and symptomatic treatment. To the onset of 15d, 8th dialysis thrombosis occurs when the internal jugular vein catheterization, hypercoagulation during dialysis, followed by gross hematuria, the skin scattered in the bleeding point, review of blood: WBCS5.2 × 10 ~ 9 / L, N0 .59, PLT43 × 10 ~ 9 / L, Hb89g / L, prothrombin time 10.3s, fibrinogen quantitative 5.7g / L, platelet aggregation