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作者报告2例儿童癫痫全身强直阵挛性发作后出现急性肺水肿。例1:9岁男孩,全身强直阵挛性发作5分钟,随后呼吸窘迫、咯粉红色泡沫痰。查:神志清,体温37℃,脉搏136次/分,呼吸38次/分,血压128/64mmHg。两肺底呼吸音弱,吸气末弥漫性啰音。心脏无杂音及奔马律,肝不大,外周无水肿。WBC19800,电解质正常,动脉血气:PO_251mmHg、PCO_235mmHg、PH7.38,心电图窦性心动过速,X线胸片双侧弥漫性肺泡浸润,心脏大小正常。静脉注射苯妥因钠、速尿,限制液体,给氧。36小时内血气迅速改善,48小时后胸片肺水肿消失。此后7个月,在8小时内4次短暂发作后又出现肺水肿,用面罩持续正压给氧及利尿剂治疗。例2:8岁男孩,出生11个月左侧大脑中动脉卒中,此后有局限性发作伴全身发作,用苯妥因钠、酰胺咪嗪及苯巴比妥控制不佳。一次全身强直性发作后呼吸
The authors report two cases of childhood epilepsy with generalized tonic clonic seizures after acute pulmonary edema. Example 1: A 9-year-old boy with global tonic-clonic seizures for 5 minutes followed by respiratory distress and slightly pink foamy sputum. Check: delirious, body temperature 37 ℃, pulse 136 beats / min, breathing 38 beats / min, blood pressure 128/64 mmHg. Breath sounds weak at the bottom of both lungs, inspiratory diffuse rales at the end. Heart no noise and gallop, liver is not large, no edema in the periphery. WBC19800, normal electrolytes, arterial blood gas: PO_251mmHg, PCO_235mmHg, PH7.38, ECG sinus tachycardia, bilateral chest X-ray diffuse alveolar infiltration, normal heart size. Intravenous phenytoin sodium, furosemide, limiting the liquid, oxygen. Rapid improvement of blood gas within 36 hours, 48 hours after chest X-ray edema disappeared. After 7 months, 4 episodes of epidural pulmonary edema occurred within 8 hours, with a mask of continuous positive pressure oxygen and diuretic therapy. Example 2: An 8-year-old boy, with a middle cerebral artery stroke on the left side of 11 months of age, had a localized episode with a generalized episode and was poorly controlled with phenytoin sodium, imipramine, and phenobarbital. Breathing after a generalized tonic episode