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患儿,男,9岁,农村居住。因烦躁2小时伴频繁抽搐入院。患儿原患“腮腺炎脑炎”在当地村卫生所治疗,短时间内(约4小时左右)超大剂量应用20%甘露醇约100ml,用药后1～2小时出现烦躁、尿频,继之出现频繁抽搐、手足搐搦,眼眶凹陷,而急转本院。入院检查:浅昏迷状,重度脱水容,频繁抽搐,手足搐搦,肌肉颤抖不止。眼眶凹陷,瞳孔双侧等大等圆,约3.5mm,对光反射迟钝。颈有抵抗,心律齐,心率速,心音低钝,两肺闻及痰鸣音、腹软,肝脾肋下未及。四肢肌张力增高,克布氏征±。血压8/6Kpa。入院后立即予吸氧、止惊、快速扩容,予二条静脉通路同时输液,总张力1/3。并及时纠酸、补钙及654—2应用。2小时内共输入液体1500ml,24小时内共输液3400ml。经过上述积极抢救,翌日,患儿神志渐转清,脱水症状改善,未再抽搐。之后改为一般常规治疗,主要活化脑细胞,补充能量合剂。住院9天,神志清楚,但懒言,精神一直萎糜,视力模糊,站立不稳,记忆力减退。住院间,头颅CT、肝肾功能、血常规检查均正常。病情稳定后,动员回家疗养。一月后来复查,其行走自如,谈吐正常,记忆力恢复,已继续上学,未见有明显后遗症。
Children, male, 9 years old, living in rural areas. Because of irritability 2 hours with frequent convulsions admitted. Children suffering from “mumps encephalitis” in the local village clinics for treatment, a short period of time (about 4 hours) large doses of 20% mannitol about 100ml, 1 to 2 hours after treatment, irritability, frequent urination, followed by Frequent convulsions, tetany, orbital sunken, and acute turn our hospital. Admission examination: shallow coma, severe dehydration capacity, frequent convulsions, tetany, muscle trembling more than. Orbital depression, pupil bilateral and other large circle, about 3.5mm, slow light reflex. Neck resistance, Qi heart rate, heart rate, heart sound low blunt, both lungs and phlegm sounds, abdomen soft, liver and spleen ribs under. Extremity muscle tension increased, Kebu’s sign ±. Blood pressure 8 / 6Kpa. Immediately after admission to oxygen, only shock, rapid expansion, to two intravenous access at the same time infusion, the total tension 1/3. And promptly correct acid, calcium and 654-2 applications. A total of 2 hours, enter the liquid 1500ml, 24 hours a total of 3400ml infusion. After the above-mentioned active rescue, the next day, children with consciousness gradually clear, dehydration symptoms improved, no further convulsions. After the general treatment instead, the main activation of brain cells, add energy mixture. Hospitalized 9 days, conscious, but lazy words, the spirit has been surging, blurred vision, standing instability, memory loss. Inpatient, head CT, liver and kidney function, blood tests were normal. After a stable condition, mobilize home for convalescence. After a review in January, its walking freely, normal conversation, memory recovery, has continued to school, no obvious sequelae.