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患者,男,32岁,病历号:58102。因进行性四肢无力2天,呼吸困难6小时,于1998年7月15日入院。2天前遇冷后双下肢对称性无力,近端重于远端,下蹲后站立困难,无力渐至双上肢。6小时前饮啤酒1000 ml后四肢活动受限,呼吸困难,心悸。查体:BP 150/90 mmHg,颅神经及深、浅感觉均未见异常,四肢肌力0级,肌张力较低,腱反射消失,病理征未引出,脑膜刺激征(-)。双肺呼吸音稍低,心率100次/min,律不齐,偶闻期前收缩,无腹胀,肠鸣音存在。急查血钾:1.73 mmol/L。初步诊断:低血钾麻痹合并呼吸肌麻痹。入院后立即吸氧,口服10‰氯化钾30 ml,静点3‰氯化钾。入院后1.5小时,心电图示频发室早,给予利多卡因100 mg静推,500 mg维持静点。患者心悸、呼吸困难及恐惧感明显。急气管插管,人工辅助呼吸。插管5分钟后心电监护突然显示室性心动过速,继之室颤,患者意识丧失,呼吸停止,双侧瞳孔5.5 mm。立即气管插管接呼吸机,用200 J、300 J各除颤1次,心律转为窦性。急查血钾1.22 mmol/L。抢救过程中给予肾上腺素、阿托品、5%碳酸氢钠、20%甘露醇、多巴胺、辅酶A、利多卡因等药物治疗。持续静脉补钾,浓度为3‰～5‰,最高补钾浓度为8‰。抢救6小时后肢体可动,6.5小时恢复自主呼吸,神志清楚,撤掉
Patient, male, 32 years old, medical record number: 58102. Due to progressive limb weakness 2 days, 6 hours of breathing difficulties, in July 15, 1998 admission. Two days ago, the symmetry of both lower extremities was weak, the proximal end was heavier than the distal end, standing difficulty after squatting and unable to gradually reach the upper extremities. 6 hours ago after drinking beer, 1000ml limited activity of the extremities, dyspnea, palpitations. Examination: BP 150/90 mmHg, cranial nerves and deep and shallow sensory were no abnormalities, limb muscle strength 0, lower muscle tone, tendon reflex disappeared, the pathological sign did not lead to meningeal irritation (-). Breathe sound slightly lower lungs, heart rate 100 beats / min, irregular, occasionally symphysis before contraction, no bloating, bowel sounds exist. Rapid check potassium: 1.73 mmol / L. Preliminary diagnosis: hypokalemia paralysis with respiratory muscle paralysis. Oxygen immediately after admission, oral 10 ‰ potassium chloride 30 ml, static point 3 ‰ potassium chloride. 1.5 hours after admission, electrocardiogram frequency room early, give lidocaine 100 mg push, 500 mg to maintain the static point. Patients palpitations, dyspnea and fear obvious. Emergency tracheal intubation, artificial assisted breathing. 5 minutes after intubation, ECG suddenly showed ventricular tachycardia, followed by ventricular fibrillation, loss of consciousness, respiratory arrest, bilateral pupil 5.5 mm. Immediate tracheal intubation connected to the ventilator, with 200 J, 300 J each defibrillation 1, the heart rate to sinus. Rapid check potassium 1.22 mmol / L. During the rescue, epinephrine, atropine, 5% sodium bicarbonate, 20% mannitol, dopamine, coenzyme A, lidocaine and other drugs were given. Continuous intravenous potassium, the concentration of 3 ‰ ~ 5 ‰, the highest potassium concentration of 8 ‰. Rescue body movements after 6 hours, 6.5 hours to resume spontaneous breathing, conscious, removed