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例1,患者男,62岁,慢性支气管炎20多年,此次急性发作,用庆大霉素8万单位,一日二次肌肉注射。用药第四天,患者家人发现其言语增多,语无伦次,精神欣快,情绪激昂,医生疑为“肺性脑病”收住院治疗。给予吸氧,并加大庆大霉素剂量,24万单位静脉滴注,每日1次,但患者症状加重,出现幻觉、谵妄、彻夜不眠。检查,神志清楚,BP120/80,口唇无紫绀,心率90次心律齐,两肺呼吸音低粗。实验室检查:血红蛋白12g%,白细胞计数8200,中性76%,淋巴21%,嗜酸3%,血清钾4.5MEq/L,钠140MEq/L,氯98Meq/L,PaO_290mmHg,PaCO_240mmHg。立即停用庆大霉素.改用口服复方新诺明。停药后次日患者精神症状明显减轻,3日后恢复正常。
Example 1, male patient, aged 62, chronic bronchitis for 20 years, the acute attack, with gentamicin 80,000 units, the second intramuscular injection. The fourth day of treatment, the patient’s family found that his speech increased, incoherent, euphoric, emotional, doctors suspected of “pulmonary encephalopathy” admitted to hospital for treatment. Give oxygen, and increase the dose of gentamicin, 24 million units intravenously 1 day, but the patient’s symptoms aggravated, hallucinations, delirium, sleepless nights. Check, conscious, BP120 / 80, no cyanotic lips, heart rate Qi Qi 90 times, both lungs sound low tone. Laboratory tests: hemoglobin 12g%, leukocyte count 8200, neutral 76%, lymph 21%, acidophilic 3%, serum potassium 4.5MEq / L, sodium 140MEq / L, chlorine 98Meq / L, PaO_290mmHg, PaCO_240mmHg. Immediately disable gentamicin. Switch to oral cotrimoxazole. The patient’s psychiatric symptoms were relieved on the next day after withdrawal, and returned to normal after 3 days.