论文部分内容阅读
王某,男,57岁。因腹胀、纳差1年,昏迷1天入院。于入院前5天,在用大剂脱水剂治疗中,出现神志淡漠,吐词不清且缓慢,继而嗜睡、昏迷。查:T36.5℃,慢性病容,压眶反射(±),巩膜轻度黄染,全身无黄染,颈稍有抵抗感,心肺(-),舟状腹,腹壁静脉显露,肝未触及,脾左侧肋下3cm,四肢肌张力高。膝反射亢进,肝脏B超,提示肝硬化、脾肿大,门、肾静脉扩张。经维持水电解质及酸碱平衡,精、谷氨酸祛氨治疗7天,仍处于深昏迷。入院第8天,另加用20％甘露醇250ml静注,间隔4小时,20％甘露醇250ml静注后,约1小时,病人神志转清,表情痛苦,自述全
Wang, male, 57 years old. Due to bloating, anorexia 1 year, coma 1 day admission. 5 days before admission, in the treatment of large doses of dehydration agent, there is a sense of indifference, unclear articulation and slow, then drowsiness, coma. Check: T36.5 ℃, chronic disease, pressure orbital reflex (±), scleral mild yellow dye, body no yellow dye, neck slightly resistance, cardiopulmonary (-), scaphoid, abdominal veins revealed, Spleen left ribs 3cm, limb muscle tension high. Knee hyperreflexia, liver B ultrasound, suggesting cirrhosis, splenomegaly, door, renal vein dilatation. After maintaining the water and electrolyte and acid-base balance, fine, glutamic acid ammonia treatment for 7 days, still in a deep coma. Admission of the first 8 days, plus an additional 20% mannitol 250ml intravenous injection, an interval of 4 hours, 20% mannitol 250ml intravenous injection, about 1 hour, the patient consciousness clear, the expression of pain, read the whole