摘要
目的探讨咪达輕仑联合阿曲库鞍治疗超难治性癫痫持续状态(SRSE)并昏迷的有效性及临床预后。方法武汉大学人民医院重症医学科2018年5月收治1例SRSE患者,对其症状、体征、实验室检查及治疗过程进行总结,结合文献复习分析治疗过程及预后。结果24岁男性患者发热4 d后出现抽搐,入院时检查血常规、血生化、凝血功能及感染指标基本正常,脑脊液未见明显异常,血中病原微生物检查提示有病毒感染的可能。脑电图(EEC)提示病变累及右侧额极-额区-颖区。头颅核磁影像(MRI)提示鼻窦炎及脑膜、海马感染可能。采用多种抗癫痫药物治疗后抽搐仍不能控制,联合咪达醴仑及阿曲库镀治疗后抽搐才得以控制,并给予抗病毒、糖皮质激素、免疫球蛋白及预防并发症等治疗。43 d后患者意识恢复,肌力逐渐改善。结论咪达睦仑联合阿曲库钱控制SRSE并昏迷患者是有效的,并可减轻后遗症。
Objective To investigate the efficacy and prognosis of using midazolam combined with atracurium for treatment of a patient with super-refractory status epilepticus (SRSE) and coma. Methods A case of SRSE and coma admitted to the Department of Critical Care Medicine of Renmin Hospital of Wuhan University in May 2018 was enrolled. The symptoms, signs, laboratory examinations and treatment process were summarized, and combined with the literature review, the therapeutic course and prognosis were analyzed. Results A male patient, 24 years old, had convulsions after 4-day fever, blood routine, blood biochemistry, coagulation function and infection indexes were basically normal on admission. There was no obvious abnormality in cerebrospinal fluid examination;blood pathogenic microorganism examination suggested that viral infection possibly occur. Electroencephalogram (EEG) showed that the lesions involved the right frontal pole-frontal area-temporal area;cranial magnetic resonance imaging (MRI) suggested that sinusitis and meningeal and hippocampal infections might be present. Although several antiepileptic drugs had been used, the convulsions could not be controlled, after combined with the application of midazolam and atracurium, the convulsions were controlled, in the mean time, antiviral drug, glucocorticoid and immunoglobulin and therapies for prevention of complications were applied. Forty-three days later, the patient's consciousness was recovered and muscle strength was gradually improved. Conclusion The combination of midazolam and atracurium is effective for controlling epileptic activities and alleviating sequelae in patients with SRSE and coma.
作者
谢文杰
王璐
黄科生
田建国
Xie Wenjie;Wang Lu;Huang Kesheng;Tian Jianguo(Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第2期238-239,共2页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
湖北省自然科学基金(2018CFB216).
