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患儿,男,17天,因全身青紫1天入院.患儿为第1胎,足月顺产,出生后无青紫.入院前2天因发热家人自行给予解热止痛散1/4包口服,体温略降,2小时后又重复服药1次,服药后约12小时发现患儿头面部、四肢青紫、拒乳、烦躁.无咳喘,无抽搐.体检:神萎,体重2.1公斤,体温36℃,全身皮肤灰紫色,口唇、指、趾端明显紫绀,呼吸 36次/分,心率138次/分,律齐,无杂音,双肺未闻罗音,肝肋下1cm,脾未及.外周血血红蛋白 184g/L,红细胞 6.75 x 10~12/L,白细胞17.1X10~9/L,中性球0.81,淋巴球0.19.入院后即给予吸氧,青紫未缓解.抽静脉血Zml呈巧克力色,振荡数分后颜色不变,随后加入1%氰化钾数滴后即变为鲜红色,诊断为药源性新生儿高铁血红蛋白血症.给予美兰4mg加人10%葡萄糖中静脉慢推,维生素 C 0.5g及细胞色素 C 15mg加人葡萄糖点滴,在推注美兰的过程中,患儿皮肤青紫逐渐减轻,1小时后青紫完全消失,抗炎治疗3天青紫无反复,治愈出院.
Children, male, 17 days, due to systemic 1 day admission hospitalized children with first-born fetus, full-term birth, no purple after birth due to fever 2 days before admission to their families to give anti- Body temperature slightly lower, 2 hours after repeated medication 1, about 12 hours after taking the drug found in children with facial, limb bruising, refusing milk, irritability. No cough, no convulsions. Physical examination: atrophy, body weight 2.1 kg, body temperature 36 ℃, systemic skin purple, lips, fingers, toe cyanosis was obvious, breathing 36 beats / min, heart rate 138 beats / min, law Qi, no noise, lungs did not hear rales, hepatic ribs 1cm, spleen did not. Peripheral blood hemoglobin 184g / L, red blood cells 6.75 x 10 ~ 12 / L, white blood cells 17.1X10 ~ 9 / L, neutral 0.81, lymphocytes 0.19 .After admission, give oxygen, purple is not relieved. Color, oscillation number of points after the same color, then add a few drops of potassium cyanide 1% into bright red after diagnosis of drug-induced neonatal methemoglobinemia given meilan 4mg plus 10% glucose in the venous slow Pushed, vitamin C 0.5g and cytochrome C 15mg add glucose drip, in the process of bolus Meilan, bruising children skin gradually reduced, 1 hour after the disappearance of bruising completely, anti-inflammatory No bruising repeated treatment three days, cured.