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患儿李××,男,6个月.因肢体烫伤去某私人诊所就诊,误输入20%甘露醇240ml后,出现频繁抽搐,急送我院.查体:T39.5℃,一般情况差,昏迷状,四肢及面部肌群频繁抽动,口唇发绀.两侧瞳孔等大等圆,光反射迟钝,呼吸56次/min,可见抽泣样呼吸,双肺未闻及罗音,心率240次/min,律齐,心搏有力,腹软,肝右肋下约3cm.胸前及两上肢、手掌处可见浅Ⅱ°烫伤,面积约2%,血压:16/12kPa.急查血常规:HB100g/L、RBC 3.00×10~(12)/L、WBC 19.6×10~9/L、N68%、L32%.血生化:血钾3.72mmol/L、血钠123.8mmol/L、血氯91.7mmol/L、血钙2.3mmol/L、CO_2CP19.2mmol/L、BUN4.9mmol/L.头颅CT显示:(1)蛛网膜下腔出血,(2)天幕缘及枕部脑内出血.入院后给予先锋铋抗感染、止血、补给1/5张含钠液,洋地黄类药物强心等一系列处理,并给予胞二磷胆碱、脑活素等增强脑细胞活性药物,入院后第二天抽搐停止,心率降至148次/min,血压9/5kPa,出现黑便,急查大便潜血(+++),血常规HB60g/L、RBC2.0×10~(12)/L,WBC11.6×10~9/L、N75%、L24%、M1%、BT2min、CT3min.立即给予输血,并给予洛赛克静注(20mg/次/d)5d,黑便停止.入院后第7天
Children Li × ×, male, 6 months due to body scalds to a private clinic, mistakenly input 20% mannitol 240ml, frequent convulsions, and promptly sent to our hospital Physical examination: T39.5 ℃, the general situation is poor, Coma, limbs and facial muscles frequently twitch, lips cyanosis .Plasma on both sides of the other round, light reflection, breathing 56 times / min, visible sobbing breath, lungs unheard and rales, heart rate 240 beats / min , Law Qi, strong heartbeat, abdominal soft, about 3cm under the right rib of the liver. Chest and upper extremity, the palm can be seen shallow Ⅱ ° scald, an area of about 2%, blood pressure: 16 / 12kPa. L, RBC 3.00 × 10-12 / L, WBC 19.6 × 10-9 / L, N68%, L32%. Blood biochemistry: blood potassium 3.72mmol / L, serum sodium 123.8mmol / L, blood chlorine 91.7mmol / L, serum calcium 2.3mmol / L, CO_2CP19.2mmol / L, BUN4.9mmol / L. Head CT showed: (1) subarachnoid hemorrhage, (2) the edge of the sky and occipital brain hemorrhage after admission to the Pioneer bismuth Anti-infective, hemostasis, supply of 1/5 Zhang sodium solution, digitalis cardiac and a series of treatment, and given citicoline, cerebrolysin and other drugs to enhance brain cell activity, the convulsions stopped the day after admission , Heart rate dropped to 148 times / min, blood pressure 9 / 5kPa, black stools, urgent check large Occult blood (+++), blood routine HB60g / L, RBC 2.0 × 10-12 / L, WBC11.6 × 10-9 / L, N75%, L24%, M1%, BT2min, CT3min Blood transfusions, and given Losec intravenous injection (20mg / time / d) 5d, black stool stop on the first 7 days after admission