患者男，50岁。半天来呕血4次，量约 1 200ml，黑便2次，量约600g，伴头晕 心悟。査体：血压80/60mmHg，心率 118次/min，神志淡漠，巩膜轻度黄染， 腹部膨隆，移动性浊音（+ ）。应首先采 取的措施是

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