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患者,男性,63岁。因“反复咳嗽咳痰15年,活动后胸闷气促5年,加重伴发热10天,神志模糊1天”而于1992年8月16日转入我院。患者于10天前受凉后咳嗽咳痰、胸闷气促加重,伴有发热,给予抗炎,解痉、祛痰等处理,因食欲不振而每日静滴10%葡萄糖注射液1000ml;入院前1天出现恶心呕吐,继之神志模糊。查体:T38℃,R28次/分,Bp12/8kPa,慢性病容,营养不良;皮肤干燥无弹性,眼结膜无水肿,唇无发绀;桶状胸,双肺散在干湿罗音,心率103次/分,P_2>A_2,未闻及杂音;四肢无水肿;腹壁反射、腱反射消失,双侧巴彬斯基征(+),克匿格征(-)。辅助检查:血K~+2.73mmol/L,Na~+105mmol/LCl~-79mmol/L,吸氧下血气示pH 7.496,PaCO_2 4.88kPa,PaO_2 13.24kPa,HCO_3~- 28.3
Patient, male, 63 years old. Because of “repeated cough and sputum for 15 years, activity chest tightness and irritability for 5 years, increased with fever 10 days, confusion 1 day” and in August 16, 1992 transferred to our hospital. Patients cough and sputum after 10 days of cold, chest tightness and shortness of breath increased, accompanied by fever, giving anti-inflammatory, antispasmodic, expectorant and other treatment, due to loss of appetite and daily intravenous infusion of 10% glucose injection 1000ml; 1 Days nausea and vomiting, followed by ambiguity. Examination: T38 ℃, R28 beats / min, Bp12 / 8kPa, chronic disease, malnutrition; dry skin inelastic, conjunctival edema, lip cyanosis; barrel chest, lungs scattered in the wet and dry rales, heart rate 103 / Min, P_2> A_2, no smell and noise; limbs without edema; abdominal reflex, tendon reflex disappeared, bilateral Babinski sign (+), Ke ange grid (-). Auxiliary examination: blood K ~ 2.73mmol / L, Na ~ 105mmol / LCl ~ -79mmol / L, oxygen gas showed under the blood gas pH 7.496, PaCO_2 4.88kPa, PaO_2 13.24kPa, HCO_3 ~ -28.3