论文部分内容阅读
病历报告黄文广医师 (同济医大协和医院外科):患者男性,30岁。因面部四肢浮肿55天入院。检查:上眼睑及双下肢凹陷性水肿。血压20/13.3kP_8(150/100mmHg)。尿蛋白(++++),透明管形0～3/HP,颗粒管形(+)。血尿素氮36.9mmol/L(52mg％),肌酐431μmol/L (4.87mg％),白蛋白20g/L(2.0g/dl),球蛋白25g/L(2.6g/dl),A/G0.78/1.01。入院后诊断:慢性肾小球肾炎。治疗经过。低钠饮食,强的松10mg、消炎痛25mg和DHCT25mg口服3次。苯丙酸诺龙25mg肌注,每周二次。多次静脉输入冻干血浆及白蛋白等。两周后病情好转,下肢浮肿明显消退。血压17.3/10.6kPa(130/80mmHg),尿蛋白(+),管形(-),血尿素氮、肌酐均正常。治疗至第29天开始有上腹隐痛,并有心慌(脉率100次/分)。第33天清晨,早餐(二两稀饭)后,突发上腹剧烈疼痛,呈持续性。检查:上腹部及右下腹腹肌紧张,压痛、反跳痛明显。肝浊音界缩小,肠鸣音减弱。站位腹部透视见双膈下游离气体。腹穿抽出炎性液体,镜检有脓
Medical records report Huang Wenguang (Tongji Medical University Hospital Surgery): Male, 30 years old. Due to facial edema 55 days admission. Check: Upper eyelid and lower limb pitting edema. Blood pressure 20 / 13.3kP_8 (150 / 100mmHg). Urine protein (++++), transparent tube 0 ~ 3 / HP, granular tube (+). Blood urea nitrogen 36.9 mmol / L (52 mg%), creatinine 431 mol / L (4.87 mg%), albumin 20 g / L (2.0 g / dl), globulin 25 g / L (2.6 g / dl), A / G0. 78 / 1.01. After admission diagnosis: Chronic glomerulonephritis. After treatment. Low-sodium diet, prednisone 10mg, indomethacin 25mg and DHCT25mg orally 3 times. Nandrolone phenylpropion 25mg intramuscularly, twice a week. Multiple intravenous injection of freeze-dried plasma and albumin. Condition improved after two weeks, lower extremity edema significantly subsided. Blood pressure 17.3 / 10.6kPa (130 / 80mmHg), urinary protein (+), tubular (-), blood urea nitrogen, creatinine were normal. Treatment began to have abdominal pain on the 29th day, and palpitation (pulse rate 100 beats / min). Day 33 morning, breakfast (two or two porridge), the sudden onset of severe abdominal pain was persistent. Check: abdominal and right lower quadrant abdominal muscle tension, tenderness, rebound pain obvious. Liver dullness narrowed, bowel sounds weakened. Station abdominal see double diaphragm under the free gas. Abdominal wear out of the inflammatory fluid, microscopy with pus