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患者男,43岁,农民。以“乏力6年,腹胀1年,神志不清2d”代诉入院。患者6年前因乏力经化验诊断为“乙型肝炎”,1年前诊断为肝硬化。2d前出现恶心呕吐,村卫生所按“急性胃炎”治疗无效且出现神志不清,大小便失禁,门诊以“肝昏迷”收住。入院后按肝昏迷给予支链氨基酸、乙酰谷酰胺及精氨酸等治疗无好转,次日查房发现患者处于深昏迷,口唇发绀,呼吸急促,节律不规则,全身皮肤多汗,可见肌束震颤,巩膜无黄染,双侧瞳孔缩小如针尖大,对光反射消失,颈软,双肺可闻及痰鸣和
Male patient, 43 years old, farmer. To “weak six years, abdominal distension 1 year, confusion 2d” on behalf of the admission. Six years ago, the patient was diagnosed as “hepatitis B” because of fatigue and was diagnosed cirrhosis one year ago. 2d before nausea and vomiting, village clinics according to “acute gastritis” treatment ineffective and unconscious, incontinence, outpatient “hepatic coma” to accept. Admission of hepatic coma after admission of amino acids, acetylglutamine and arginine no improvement in the treatment, the next day found that the patient was in a deep coma, lips cyanosis, shortness of breath, irregular rhythms, sweating of the body skin, visible muscle bundle Tremor, sclera no yellow dye, bilateral miosis, such as needle tip large, light reflex disappeared, neck soft, lungs can be heard and phlegm and