论文部分内容阅读
1 病例资料例1:男,33岁.腰椎间盘突出术后左下肢疼痛再发2个月入院.入院后行椎管造影检查.术中将76%泛影葡胺10ml误当作碘必乐注入蛛网膜下腔,拍片显示为L_5～S_1椎间盘突出.术后半小时患者出现头晕、恶心、四肢轻度抽搐.45min后症状迅速加重,四肢痉挛性抽搐,角弓反张,牙关紧闭,呼吸极度困难,意识丧失.继之全身发凉、出冷汗,口唇及趾、指端紫绀.心率127次/分,血压12/7kPa,体温39.7℃.急行气管切开插管、高频呼吸机人工呼吸、给氧、抗痉挛、抗休克、激素、物理降温及纠正电解质紊乱等治疗.同时查证造影剂使用错误,即予脱水、利尿以降低颅内压,促进药物排泄.硫代硫酸钠解除部分中毒症状,并预防性使用抗生素.经积极抢救,于造影后5h患者抽搐基本控制.3天后患者生命体征稳定,停用高频呼吸机.查血氧饱和度、血气分析、电解质等各项指标正常.于造影后第4天拔除气管插管,病人迅速康复.3周后予手术行L_5～S_1髓核摘除术.术后腰腿痛消失.10天后出院.术后1年复查未发现明显后遗症.
1 case data Example 1: male, aged 33. Left lower extremity pain after lumbar disc herniation recurrence of 2 months admitted to hospital after spinal canal angiography, intraoperative 76% diatrizoate 10ml mistaken for iodine Injected into the subarachnoid space, the film showed L_5 ~ S_1 disc herniation after half an hour patients with dizziness, nausea, limbs mild convulsions .45 minutes after the rapid increase in symptoms, limb spasm convulsions, angle arch anti-Zhang, Breathing is extremely difficult, loss of consciousness, followed by whole body cool, sweat, lips and toes, finger cyanosis heart rate of 127 beats / min, blood pressure 12 / 7kPa, body temperature 39.7 ° C. Emergency tracheotomy cannula, high-frequency ventilator Artificial respiration, oxygen, anti-spasm, anti-shock, hormones, physical cooling and electrolyte imbalance correction treatment.At the same time verify the use of contrast media error, that is, to dehydration, diuretic to reduce intracranial pressure and promote drug excretion. Some of the symptoms of poisoning, and the prophylactic use of antibiotics.After active rescue, 5h after angiography in patients with basic control of convulsions .3 days after the patient’s vital signs stable, disable high-frequency ventilator. Check oxygen saturation, blood gas analysis, electrolytes and other The index is normal Removal of endotracheal intubation, rapid recovery of patients .3 weeks after surgery line L_5 ~ S_1 nucleus removal .Postoperative low back pain disappeared .10 days after discharge .After 1 year review found no significant sequelae.