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患者,男,44岁,主因间断意识不清3天就诊。3天前不明原因出现意识不清,小便失禁,到当地就诊。测血糖1.7 mmol/L,给予静点10%葡萄糖500ml加50%葡萄糖100ml,意识转清,以后工作娱乐如常。1小时前因晨起不能唤醒(9小时前入睡)而来我院。既往体健。查:T/36.3℃,P80次/min,R16次/min,BP110/70mmHg。昏迷状态,压眶无反应,巩膜无黄染,无肝掌及蜘蛛痣。心肺未见异常。腹平软,肝助下2cm,质硬。脾未触及,移动性浊音阴性。双下肢无浮肿。双侧巴氏征(±)。血糖1.9 mmol/L,给予静点50%及10%葡萄糖,使血溏维持在7～10 mmol/L并给予甘露醇脱水、促醒及脑细胞代谢药物,仍处于昏迷状态。行头颅CT无异常。脑电图示:广泛高度异常。肝胆胰CT及强化CT发现肝右叶6cm×6cm×6cm占位病变,AFP>1000μg/L。肝功能
The patient, male, was 44 years old, and the patient was unconscious for 3 days due to intermittent discomfort. Unclear consciousness, urinary incontinence, and local medical consultation occurred 3 days earlier. Measure blood glucose 1.7 mmol/L, give a 10% glucose 500ml plus 50% glucose 100ml, the consciousness turns clear, after work and entertainment as usual. One hour earlier I could not wake up (sleeping 9 hours ago) from our hospital. Past health. Check: T/36.3°C, P80/min, R16/min, BP110/70mmHg. Coma, unresponsive pressure, no yellow stain on the sclera, no liver palms and spider mites. No abnormalities in heart and lung. The abdomen is soft, the liver helps 2cm, and it is hard. The spleen is not touched and the mobile dullness is negative. No edema in both lower limbs. Bilateral Pakistani sign (±). The blood glucose was 1.9 mmol/L, 50% of the static points and 10% of glucose were given, and the blood stasis was maintained at 7 to 10 mmol/L and the mannitol was given dehydration, awakening, and metabolism of brain cells, which were still in a coma. There was no abnormality in head CT. EEG icon: Widely abnormal height. Hepatobiliary and pancreatic CT and enhanced CT revealed a 6cm×6cm×6cm occupying lesion in the right lobe of the liver with AFP >1000 μg/L. liver function