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1 病例介绍 患者,男,72岁,因右额部疱疹9d,头痛、嗜睡1d入院。查体:T37℃,右额可见成簇小水疱。双侧瞳孔等大,光反射存在,颈有抵抗力,心肺正常,腹软,肝脾未触及。病理检查:巴氏征、克氏征阴性,布氏征阳性。查尿常规、肾功能均正常,头颅CT示:轻度脑萎缩。脑脊液检查:无色透明,蛋白(一),糖3.8mmol/L,氯化物96mmol/L,WBC 75×10~6/L,单核0.66,多核0.34。入院诊断:带状疱疹并发病毒性脑膜炎。用20％甘露醇250ml,静脉滴注.q8h.青霉素预防感染,加用地塞米松和能量合剂,患者症状逐渐减轻。至第5天突然少尿,24h尿量仅190ml,急查肾功能:BUN 17.9mmol/L,Cr 280/μmol/L,考虑为急性肾功能衰竭。立即停用甘露醇,改为50％高渗
1 case description The patient, male, 72 years old, due to right frontal herpes 9d, headache, drowsiness 1d admission. Physical examination: T37 ℃, visible clusters of small blisters on the right forehead. Bilateral pupils and other large, light reflection exists, neck resistance, normal heart and lung, abdominal soft, liver and spleen not touched. Pathological examination: Pap’s sign, Kirschner sign negative, Brinell sign positive. Check urine, renal function are normal, head CT showed: mild brain atrophy. Cerebrospinal fluid examination: colorless and transparent, protein (a), sugar 3.8mmol / L, chloride 96mmol / L, WBC 75 × 10 ~ 6 / L, mononuclear 0.66, multinucleated 0.34. Admission diagnosis: shingles complicated with viral meningitis. With 20% mannitol 250ml, intravenous infusion. Q8h. Penicillin to prevent infection, plus dexamethasone and energy mixture, the patient’s symptoms gradually reduced. To the first 5 days of sudden oliguria, 24h urine output was only 190ml, acute renal function: BUN 17.9mmol / L, Cr280 / μmol / L, considered acute renal failure. Immediately disable mannitol, replaced by 50% hypertonic