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病人,男性,年龄70岁.因排尿困难9年,尿线细,射程变短,排尿时间延长,排尿中断,有时呈滴淋状,住院.查体:神志清醒,能准确回答问题,四肢活动正常,步入病房.肛查前列腺Ⅲ度肥大,中央沟消失.B超提示:前列腺前后径5.5cm大小.术前血压22/14KPa,心电图正常.胸片示;慢性支气管炎、肺气肿,电解质、肝肾功能正常.诊断:前列腺Ⅲ度增生.在持硬麻下,行耻骨上经膀胱前列腺切除术,切除前列腺重105克.术中麻醉效果良好,但血压一度降至12/9KPa约10分钟.术中失血约500ml,输血400ml,手术历时2小时.病人回病房后一直嗜睡,术后第一天右侧肢体出现轻度偏瘫,肌力Ⅲ级.急诊头颅CT示:(1)左顶叶及枕叶梗塞性脑软化灶(面积约5×5cm,占四层);(2)双侧基底节区多发陈旧性腔隙性梗塞灶.诊断:左侧脑分水岭梗塞.行气管切开、脱水、激素、活血化瘀、神经营养等综合治疗.病人脑水肿缓解、肢体肌力恢复至Ⅳ级,痊愈.
Patient, male, age 70 years old. Due to dysuria 9 years, fine lines, short range, prolonged urination, urination interrupted, sometimes dripping, hospitalized. Physical examination: conscious, can accurately answer questions, limbs activities Normal, into the ward anal anal Ⅲ degree hypertrophy, central ditch disappeared. B-Tip: prostate size before and after 5.5cm. Preoperative blood pressure 22 / 14KPa, normal ECG. Chest X-ray; chronic bronchitis, emphysema, Electrolyte, liver and kidney function is normal .Diagnosis: Prostate Ⅲ degree hyperplasia .Under the hard anesthesia, the line suprapubic transurethral resection of the prostate, resection of prostate weight 105 grams.Anesthetic effect is good, but the blood pressure was reduced to 12 / 9KPa about 10 minutes. Intraoperative blood loss of about 500ml, blood transfusions 400ml, surgery lasted 2 hours after the patient back to the ward has been lethargy, right limb paralysis, muscle strength Ⅲ grade on the first day after surgery. Emergency head CT showed: (1) Left parietal lobe and occipital infarction of cerebral softening (area of about 5 × 5cm, accounting for four); (2) bilateral basal ganglia multiple old lacunar infarction. Diagnosis: left brain watershed infarction. Tracheal Cut, dehydration, hormones, blood circulation, neurotrophic and other comprehensive treatment of patients with brain edema relief, limb muscle Power restored to Ⅳ level, healed.