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患者,男,40岁,农民。主要因腹胀1天伴四肢无力收住普外科。入院检查:体温73℃,脉搏138次/min,呼吸30次/min,血压155/105 mmHg,四肢肌力Ⅱ级,血钾2.7 mmol/L,钠140 mmol/L,氯102 mmol/L,二氧化碳结合力18 mmol/L,白细胞34×10~9/L,中性87.7%,淋巴15.3%,腹部透视示肠胀气,入院后抗感染、对症治疗的同时给予10%葡萄糖1000 ml,林格氏液500 ml,10%氯化钾35 ml。入院3小时,患者自觉胸闷、憋气。心电图示室上性心动过速。值班医生给予西地兰0.4 mg静点,1小时后呼吸困难加重,大汗淋漓,烦躁不安,出现间停呼吸。心电监护示血氧饱和度60%。急请重症监护病房会诊。查血气分析:pH7.35,PaO_2 50mmHg,PaCO_2 45 mmHg,AB 20 mmol/L,BE-2 mmol/L。再次追问病史,家属诉四肢无力反复发作3年,入院前1次,由于酒醉后喝糖水,出现腹胀,四肢无力。考虑低钾性麻痹致室上性心动过速,呼吸肌无力致急性呼吸衰竭,立即给予呼吸机辅助呼吸,异博定10mg静点,室上速无改善。后胃管内注入10%氯化钾30 ml,每4小时1次,心率逐渐下降,呼吸改善,四肢肌力有所恢复,24小时静脉补钾9.0 g,口服补钾12.0 g。住院3天痊愈出院。讨论:周期性麻痹是以周期性反复发作的骨骼肌弛缓性无力或瘫痪为特征的一种肌肉性疾病。大多伴有血钾过低、饱食、酗酒、剧烈运动、寒冷、精神过度紧张,注射葡萄糖可诱发。发作时钾离子过度的进入肌细胞内,引起肌膜电位的去极化,导致神经一
Patient, male, 40 years old, farmer. Mainly due to bloating 1 day with limb weakness to receive general surgery. Admission examination: body temperature 73 ℃, pulse 138 beats / min, breathing 30 beats / min, blood pressure 155/105 mmHg, muscle strength Ⅱ limbs, potassium 2.7 mmol / L, sodium 140 mmol / L, chlorine 102 mmol / Carbon dioxide binding 18 mmol / L, white blood cells 34 × 10 ~ 9 / L, neutral 87.7%, lymphatic 15.3%, abdominal gas showed flatulence, hospital infection, symptomatic treatment given 10% glucose 1000 ml, Ringer 500 ml of solution, 35 ml of 10% potassium chloride. Admission 3 hours, the patient conscious chest tightness, suffocation. ECG showed supraventricular tachycardia. On duty physician given cedilanid 0.4 mg static point, 1 hour later, dyspnea increased, sweating, restlessness, intermittent respiration. ECG shows oxygen saturation 60%. Urgent ICU consultation. Check blood gas analysis: pH7.35, PaO_2 50mmHg, PaCO_2 45 mmHg, AB 20 mmol / L, BE-2 mmol / L. Asked again history, family members v. Extremities weakness repeated episodes of 3 years, 1 time before admission, due to drunk after drinking syrup, abdominal distension, limb weakness. Consider hypokalemic paralysis caused by supraventricular tachycardia, respiratory muscle weakness caused acute respiratory failure, immediately ventilator-assisted breathing, different Bo Ding 10mg static point, no improvement in supraventricular tachycardia. After gastric tube injection of 10% potassium chloride 30 ml, once every 4 hours, the heart rate gradually decreased, breathing improved limb muscle strength has been restored, 24 hours intravenous potassium 9.0 g, oral potassium 12.0 g. 3 days hospitalized cured. Discussion: Periodic paralysis is a muscular disease characterized by periodic recurrent seizures or paralysis of skeletal muscle. Mostly accompanied by hypokalemia, satiety, alcoholism, strenuous exercise, cold, over-stress, injection of glucose can be induced. Attack of excessive potassium ions into the muscle cells, causing depolarization of the myoelectric potential, leading to a nerve