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1例65岁男性因肺炎合并呼吸衰竭,给予高流量吸氧,亚胺培南-西司他丁钠0.5 g、1次/8 h静脉滴注,万古霉素0.5 g、1次/8 h静脉滴注,莫西沙星0.4 g、1次/d静脉滴注,甲泼尼龙160 mg/d静脉滴注。治疗3 d病情控制不佳,行气管插管和呼吸机机械通气,因患者出现躁动应用维库溴铵4 mg静脉推注,4～6 h重复给药(16～20mg/d),同时甲泼尼龙减量至80 mg/d静脉滴注。治疗5 d患者出现睁眼困难,肌力下降,四肢腱反射减弱,肌酸激酶(CK)650 U/L,考虑为急性类固醇肌病。停用维库溴铵,改为丙泊酚,甲泼尼龙减量至40 mg/d静脉滴注。2 d后症状缓解,睁眼困难消失,四肢肌力逐渐恢复。5 d后患者CK 119 U/L,肌无力症状完全消失。
A 65-year-old man with pneumonia complicated with respiratory failure was given high-flow oxygen inhalation. Imipenem-cilastatin sodium 0.5 g, once / 8 h, vancomycin 0.5 g, once / 8 h Intravenous drip, moxifloxacin 0.4 g, 1 / d intravenous infusion, methylprednisolone 160 mg / d intravenous infusion. Treatment of 3 d disease control poor endotracheal intubation and ventilator mechanical ventilation, intravenous injection of vecuronium 4 mg intravenous injection of patients due to agitation, 4 ~ 6 h repeated administration (16 ~ 20mg / d), at the same time A Prednisolone reduction to 80 mg / d intravenous infusion. After 5 days of treatment, patients with open eyes had difficulty in opening their eyes, decreased muscle strength and weakened tendon reflexes of the extremities. Creatine kinase (CK) 650 U / L was considered as acute steroid myopathy. Vecuronium bromide was discontinued, replaced by propofol, methylprednisolone reduced to 40 mg / d intravenous infusion. Symptoms were relieved after 2 days, difficulty in opening eyes disappeared, and muscle strength of limbs gradually recovered. After 5 days CK 119 U / L, myasthenia gravis disappeared completely.