| 女性，25岁。5年来劳累后心悸、气短，3天来间断咯血，无发热。查体：双颊紫红，颈静脉无怒张，双肺未闻及干、湿性啰音，心浊音界在胸骨左缘第三肋间向左扩大，心尖部可闻及舒张期隆隆样杂音，第一心音亢进，腹平软，肝脾肋下未能及，下肢无水月中。 |
该患者最紧急的治疗是
A．急诊手术
B．输液、输血
C．急诊胃镜止血
D．静脉给予质子泵抑制剂
参考答案：B
解析：[考点] 食管胃底静脉曲张破裂出血的诊断和治疗
[分析]： 该中年男性患者突然大量呕血和黑便，血压已经下降，结合过去有“肝功能异常”史和目前查体有黄疸，最可能的出血原因是食管胃底静脉曲张破裂出血，其余三种病因均很少会突然发生这样大量出血；大量上消化道出血后应该腹部肠鸣音活跃，至少是正常，不会消失，因为肠鸣音代表活动性出血的程度；该患者有肝硬化，所以肝未触及和腹部移动性浊音阳性是会有的；应该有脾大，但因大出血后，脾可能摸不到。紧急治疗是输液和输血，纠正低血压，手术或内镜止血只能等血压控制后，可以静脉给予质子泵抑制剂，但不是最重要的紧急治疗。
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