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患者男,70岁,复视、眼睑下垂6个月,症状晨轻暮重,休息可好转。查体:内科检查正常。左眼球内收稍差,双眼睑轻度下垂,疲劳实验阳性,四肢肌力V级,生理反射存在,病理反射(-)。肌电图重度电刺激低频波幅递减。诊断:重症肌无力。患者服中药时误将炙马钱子粉1.0g一次冲服,30分钟后出现面部肌肉僵硬、胸闷、咽部发紧,继而全身强直性惊厥发作,持续数秒钟,意识清楚,无瞳孔散大,无尿失禁,轻微刺激即可诱发痉挛。血压140/70mmHg,心率100次/min。给予安定5mg静脉注射后症状缓解。讨论:马钱子种子主要含番木鳖碱(士的宁)和马钱子碱,口服后很快被吸收。番木鳖碱首先选择性兴奋脊髓,加快神经冲动在脊髓中的传导,从而增强骨骼肌的紧张度;其次,兴奋延髓的呼吸中枢、血管运动中枢及大脑皮质。作用机理为:(1)阻
Male patient, 70 years old, diplopia, eyelid ptosis 6 months, the symptoms of morning and evening heavy, rest can be improved. Physical examination: normal examination. Left eye adduction slightly worse, double eyelid ptosis, fatigue test was positive, limb muscle strength V class, the presence of physiological reflex, pathological reflex (-). Electromyography severe electrical stimulation of low frequency amplitude decreased. Diagnosis: Myasthenia gravis. Patient service mistakenly Sunburn Strychnos powder 1.0g a blunt, 30 minutes after facial muscle stiffness, chest tightness, pharyngeal hair tight, and then the onset of tetanic convulsions for a few seconds, awareness, no pupil scattered, Urinary incontinence, mild irritation can induce cramps. Blood pressure 140 / 70mmHg, heart rate 100 beats / min. Given stable 5mg intravenous injection of symptoms. Discussion: Strychnos seeds contain mainly strychnine (strychnine) and brucine, oral absorption soon after. Strychnine first selective excitement of the spinal cord, nerve conduction in the spinal cord to speed up the transmission, thereby enhancing the skeletal muscle tension; Second, the excitement of the medullary respiratory center, vascular motor center and the cerebral cortex. The mechanism of action is: (1) resistance