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1例42岁女性患者,因患急性胃肠炎给予口服甲氧氯普胺10mg,3次/d;阿莫西林1.0g,3次/d。首次服药30min后,患者出现四肢不自主运动,行走困难,头颈向左扭转,下颌偏斜,吐舌,语言含糊。查体:T36.5℃,P96次/min,R24次/min,BP100/70mmHg,神志清楚,反应迟钝,面具脸,头颈向左侧扭转,双侧腱反射亢进,病理反射阴性。考虑为甲氧氯普胺所致锥体外系反应,立即给予阿托品1mg肌内注射,地西泮5mg肌内注射。30min后上述症状逐渐消失。停服甲氧氯普胺,继续服用阿莫西林,上述症状未再出现。
One 42-year-old female patient received oral metoclopramide 10 mg three times daily for acute gastroenteritis, amoxicillin 1.0 g three times daily. After the first medication 30min, the patient appeared involuntary movements of limbs, walking difficulties, head and neck turn left, skewed mandibular, tongue, vague language. Examination: T36.5 ℃, P96 times / min, R24 times / min, BP100 / 70mmHg, conscious, unresponsive, face mask, head and neck to the left to reverse the bilateral tendon hyperreflexia, pathological reflex negative. Consider the metoclopramide induced extrapyramidal reactions, immediately given atropine 1mg intramuscular injection, diazepam 5mg intramuscular injection. After 30min the above symptoms gradually disappear. Stop taking metoclopramide, continue taking amoxicillin, the above symptoms did not appear again.