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患儿女,13岁。因气短、咳嗽10余天,近1天喘憋、烦躁急转我院。查体:急重病容,喘憋、青紫。脉搏152次/分,呼吸40次/分,血压22/16kPa。辅助检查血尿便、肝肾功能、血气分析及血钠、血氯均正常,唯血钾2.69mmol/L。X 线示心脏明显扩大,有肺水肿。心脏超声:心室、心房普遍扩大,心功能中度异常,血管数字减影证实左肾动脉闭塞,右肾动脉狭窄。诊断为多发性大动脉炎、高血压、心力衰竭。给予吸氧、镇静,利血平、速尿,2小时后共排尿600ml,病情稍平稳。血压仍21/15kPa,给巯甲丙脯酸25mg 口服,1小时后发现血压测不到,然患儿面色、肤色均红润,肢端温暖。给去甲肾上腺素、多巴胺等抗休克。次日将巯甲丙脯酸改为8.3mg,每日3次,血压18/12kPa,3天后改为12.5mg每日4次,并加心痛定控制高血压。
Children with children, 13 years old. Due to shortness of breath, cough for more than 10 days, nearly 1 day wheezing, irritable to our hospital. Physical examination: critical illness, wheezing, bruising. Pulse 152 beats / min, breathing 40 beats / min, blood pressure 22 / 16kPa. Assisted examination of hematuria, liver and kidney function, blood gas analysis and blood sodium, blood chlorine were normal, the only potassium 2.69mmol / L. X-ray showed significantly enlarged heart, with pulmonary edema. Echocardiography: Ventricular, atrial widening, abnormal cardiac function, digital subtraction of blood vessels confirmed left renal artery occlusion, right renal artery stenosis. Diagnosis of multiple arteritis, hypertension, heart failure. Give oxygen, sedation, reserpine, furosemide, 2 hours after urination 600ml, slightly stable condition. Blood pressure is still 21 / 15kPa, 25mg orally administered captopril, 1 hour after the blood pressure was found, however, children with complexion, complexion are rosy, extremities warm. To norepinephrine, dopamine and other anti-shock. The next day captopril will be changed to 8.3mg, 3 times a day, blood pressure 18 / 12kPa, 3 days later changed to 12.5mg 4 times a day, and heartburn control of hypertension.