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1 病例介绍 患者,男,63岁,因反复乏力、纳差、肝功不良9年,加重3月,伴消化道出血,于1994年9月27日以“肝硬化、消化道出血”收治入院。入院时T36℃,P76次/min,R17次/min,BP15/10kPa,神智清楚,精神差,消瘦,经止血,护肝及支持治疗,病情好转。10月26日再次出现消化道出血,出血量1000ml,伴休克,BP8/6kPa,经输血,止血药治疗后休克不能纠正,即应用多巴胺治疗,剂量10％葡萄糖250ml+多巴胺20mg静滴,20～30滴/min。输液过程中注射部位出现液体外渗,组织水肿,1日多次更换注射部位。11月3日患者左上臂内侧静脉穿刺部位出现烫伤样水泡,后融为一片,基底呈暗红色,面积5cm～10cm,右上肢伴有散发小水泡。在排除烫伤及其他药物副作用后疑为多巴胺外渗致组织坏死,立即改为下肢静脉注射,并在无菌操作下抽出渗出液,生理盐水加庆大霉素湿敷,无菌纱布覆盖并加压包扎,换药1次/d,渗出物减少后隔日换药1次,11月6日伤口渗出物明显减少,10d伤口干燥、结痂,无感染发生。
1 case description The patient, male, 63 years old, due to repeated fatigue, anorexia, liver dysfunction for 9 years, increased in March, with gastrointestinal bleeding in September 27, 1994 with “liver cirrhosis, gastrointestinal bleeding” admission admitted . Admission T36 ℃, P76 times / min, R17 times / min, BP15 / 10kPa, clear mind, poor spirits, weight loss, hemostasis, liver protection and supportive care, the condition improved. On Oct. 26, gastrointestinal bleeding was reoccurred and the amount of bleeding was 1000ml. With shock, BP8 / 6kPa, blood transfusion and hemostatic treatment could not correct the shock. That is, dopamine treatment was used. Dose of 10% glucose 250ml + dopamine 20mg, 20-30 Drops / min. In the process of infusion of liquid extravasation occurs at the injection site, tissue edema, on the 1st many times to replace the injection site. On November 3, scalded blisters appeared on the medial venipuncture site in the left upper arm of the patient and melted into a piece. The base was dark red with an area of 5 cm to 10 cm. The right upper extremity was accompanied by small blisters. In the exclusion of scalds and other side effects of drugs suspected of extra-dopamine tissue necrosis, immediately replaced by intravenous injection of the lower extremities, and under excretion in aseptic extraction, saline plus gentamicin wet compress, sterile gauze and Pressure dressing, dressing 1 / d, the excretion of dressing change every other day 1, November 6 wound exudate decreased significantly, 10d the wound dry, scab, no infection.