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患者,女,30岁.因怀孕8个月前置胎盘大出血,胎死宫内1h,失血性休克10h,由外院转入.入院时呈重度休克状态,给予抗休克处理,仅在左上肢一管加压输液5600ml,血1154ml,并用2.5%盐水300ml,血压升至8/4kpa行剖宫产取胎术,术中输血730ml,林格氏液500ml,术后发现左上肢轻微肿胀.未发现有静脉炎表现.患者少尿,给速尿20mg,尿量增至1200ml,尿常规见有RBC+.次日病人左上肢出现水泡,肿胀加剧,指端皮肤发黑,发紫,疼痛剧烈、麻木,手指屈曲状,不能活动,以中、环指明显,局部压痛,手指有牵拉痛.请骨科会诊,诊为骨筋膜室综合征,每日给20%甘露醇250ml快速输入,2h后重复一次,共2次.治疗3天后肿胀消失,疼痛减轻,手指活动自如.
Patients, female, 30 years old due to pregnancy placenta accretaemia bleeding 8 months, fetal death 1h, hemorrhagic shock 10h, transferred from outside the hospital admission was severe shock, given anti-shock treatment, only in the left upper limb Tube pressure infusion 5600ml, blood 1154ml, and with 2.5% saline 300ml, blood pressure rose to 8 / 4kpa cesarean section fetus surgery, intraoperative blood transfusion 730ml, Ringer’s solution 500ml, postoperative left upper limb slightly swollen. There phlebitis patients with oliguria, furosemide to 20mg, urine output increased to 1200ml, urine routine see RBC + the next day the patient left upper limb blisters, swelling worse, finger-side skin black, purple, severe pain, numbness , Finger flexion-like, can not activity, in the ring marked, partial tenderness, fingers have pulling pain. Please orthopedic consultation, diagnosed with compartment syndrome, daily 20% mannitol 250ml quick input, 2h after Repeat once, a total of 2 times.After 3 days of treatment, the swelling disappears, the pain is relieved, and the finger moves freely.