论文部分内容阅读
快速静点２０％甘露醇过敏一例河北省唐山市开平区医院（０６３０００）郭士萍病人男，７１岁。主因右侧肢体活动障碍，伴失语５小时。于１９９０年１２月２５日１６时３５分入院就诊，查体Ｔ３６．５，Ｐ６２，Ｒ２０，Ｂｐ２２／１４ｋＰａ。病人神清，反应迟钝，双侧瞳孔大小正园，对光压眶反射存在，呼吸平稳，左侧鼻唇沟变浅。伸舌偏向右侧。右上下肢肌力０级，肌张力正常，巴氏征阳性。青霉素皮试阳性，１６时４５分遵医嘱静点２０％甘露醇２５０ｍｌ，１６时５０分病人手背出现以针刺点为中心的药疹显水泡状，并快速扩大到整个手背。即测Ｂｐｌｌ／８ｋＰａ心率１２０次，呼吸４０，立即停止静点。给速尿２０ｍｇ，氟美松５ｍｇ加５０％葡萄糖静推，经１５分钟后血压心率、呼吸恢复正常，药疹经无菌处理未发生感染。讨论：甘露醇是一种己六醇，由于不易从毛细血管透入组织，故能提高血浆渗透压，把组织中储留水份吸回到血液中产生脱水效果。临床上用于预防急性肾功能衰竭，也用于降低颅内压脓内压。此药的使用范围广泛，静点时少数人可出现头痛、头晕，视力模糊等副作用，很少出现过敏症状。本例静点甘露醇５分钟后出现过敏，抗过敏治疗有效，值得在临床应用中借鉴。快速静点20%甘露醇过敏一例@
Rapid static point 20% mannitol allergy case Kaiping District Hospital in Tangshan City, Hebei Province (063000) Guo Shiping patients male, 71 years old. The main reason for the right limb movement disorders, with aphasia for 5 hours. On December 25, 1990 at 16:35 on admission, physical examination T36.5, P62, R20, Bp22 / 14kPa. Clear patient, unresponsive, bilateral pupil size is park, the existence of pressure orbital reflex, breathing steady, shallow left nasolabial fold. Tend to the right side of the tongue. Right upper extremity muscle strength 0, normal muscle tone, positive Papamia sign. Penicillin skin test positive, 16:45 20% mannitol prescribed by the static point of 250ml, 16:50 patients appear on the back of the hand acupuncture point drug-eruption blister-like, and quickly expanded to the back of the hand. That measured Bpll / 8kPa heart rate 120 times, breathing 40, stop static point immediately. To furosemide 20mg, 5mg dexamethasone plus 50% glucose static push, after 15 minutes of blood pressure heart rate, resumed normal breathing, drug eruption by sterile treatment without infection. Discussion: Mannitol is a hexitol, because it is not easy to penetrate into the tissue from the capillaries, it can increase the plasma osmolality, the water stored in the organization sucked back into the blood dehydration effect. Clinically for the prevention of acute renal failure, also used to reduce intracranial pressure pus. The wide range of use of this medicine, a small number of people may be static point headache, dizziness, blurred vision and other side effects, rarely appear allergy symptoms. In this case static mannitol after 5 minutes allergy, anti-allergy treatment is effective, it is worth learning from the clinical application. Fast static point 20% mannitol allergy case @