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男,42岁。上腹剑突下疼痛7天入院。疼痛无明显规律、呃逆、恶心。查体:消瘦,口张正常,神清。颈软,心肺正常。腹平坦,上腹剑突下肌紧张,有压痛、反跳痛。住院后经抗炎、补液、中药治疗,腹痛范围扩展至全腹,持续性伴阵发性加剧。呈板状腹,满腹压痛,反跳痛。拟诊为消化性溃疡并穿孔。继续给予补液,抗炎治疗,腹痛仍无好转。第3天出现四肢阵发性抽搐,给予钙剂无缓解。下午胃镜检查时出现牙关紧闭,全身抽搐,角弓反张,颈项强直。再次追问病史,半月前,
Male, 42 years old. Upper abdominal xiphoid pain 7 days admitted. No obvious law of pain, hiccups, nausea. Physical examination: weight loss, mouth normal, clear. Neck soft, normal heart and lung. Abdomen flat, abdominus muscle tension, tenderness, rebound tenderness. After hospitalized by anti-inflammatory, rehydration, Chinese medicine treatment, abdominal pain range extended to the whole abdomen, persistent sexual intercourse intensified. Was abdominal plate, full of tenderness, rebound tenderness. To be diagnosed as peptic ulcer and perforation. Continue to give rehydration, anti-inflammatory treatment, abdominal pain still no improvement. On the third day, there were paroxysmal convulsions on the limbs and no relief of calcium was given. Appear during the afternoon gastroscopy closed twitches, body twitching, angle arch anti-Zhang, neck stiffness. Asked again history, half a month ago,