论文部分内容阅读
患者男,32岁.因频繁惊厥1小时于1992年11月20日入院.家属代诉患者入院前2.5小时一次自服异烟肼25g,1.5小时后出现呕吐.出汗、言语不清,继之频繁阵发性抽搐,神态不清.查体:T36.4℃,P123次/分,R28次/分,BP13/8KPa.昏迷状,频繁短阵抽搐.压眶反射消失.瞳孔等国.直径约3mm.光反射迟纯.唇发绀.颈软.双肺呼吸音粗糙,心律齐,123次/分,未闻及杂音.腹软,未扪及肝.脾,神经系统未查及可靠阳性病理征,诊断:急性异烟肼中毒.抢救经过:迅速建立两条静脉通道并上氧.立即反复静注安定直至抽搐停止(总量25mg).继以30mg加入500ml液体中缓慢静滴,同时相继给予维生素B_6(静注两次.首次10g,第二次5g,后又分次滴入9g)、甘露醇(快速静滴两次,每次50g)及碳酸氢钠(静滴12:5g).抽搐控制后即上胃管用清水洗胃(共15000ml).洗胄后不久,患者呼吸骤停,立即气管插管接人工呼吸机,5小时后自主呼吸恢复.停机观察3小时,查动脉血气分析基本正常.拔管.入院后12小时病人出现疼痛反应.15小时后完全清醒.但有发热,痰黄绿而稠;以大剂量抗生素联合应用,3天后控制,住院一周痊愈.此间尚采取了防治心,肝、肾功能受损和维持水、电解质及酸碱平衡等治疗措施.
Male patient, aged 32, was admitted for hospitalization on November 20, 1992 due to frequent convulsions for 1 hour, and her family members complained of vomiting of isoniazid 25 g 2.5 hours prior to admission to patients with vomiting after 1.5 hours. The frequent paroxysmal convulsions, confidante. Examination: T36.4 ℃, P123 times / min, R28 beats / min, BP13 / 8KPa. Coma, frequent short-twitch. Pressure orbital reflex disappears. Diameter of about 3mm. Delayed light reflex. Lips cyanosis. Neck soft. Respiratory sounds of lungs rough, Qi Qi, 123 beats / min, no smell and noise. Abdominal soft, palpable liver. Spleen, nervous system has not been verified and reliable Positive pathological signs, diagnosis: acute isoniazid poisoning .After the rescue: the rapid establishment of two venous access and oxygen .Amotest intravenousstimulation until seizures stopped (total 25mg.) Followed by 30mg added 500ml liquid slow intravenous infusion, At the same time they were given vitamin B_6 (intravenous twice for the first time, 10g for the second time, 5g for the second time, 9g for the second time), mannitol (50g for fast intravenous infusion and 50g for each time) and sodium bicarbonate (12: 5g.) After convulsions control on the gastric tube gastric lavage (a total of 15000ml.) Soon after the wash, the patient stopped breathing immediately tracheal intubation artificial respirator, spontaneous breathing recovery after 5 hours. 3 hours, check the arterial blood gas analysis is normal .Extraction .12 hours after admission patients with pain reaction .15 hours after completely awake.But with fever, yellow and green thick sputum; combined with high-dose antibiotics, 3 days after the control, hospitalization Healed a week.Also taken during the prevention and treatment of heart, liver and kidney dysfunction and maintenance of water, electrolyte and acid-base balance and other treatment measures.