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患者,男,36岁。缘右足底外伤后3d,出现疲倦、乏力、头晕,伴四肢抽搐数次入院,诊断为全身型破伤风。入院后经支持对症等治疗5d后不但疗效不佳,且出现咀嚼肌、面肌、颈项肌、腹背肌、四肢肌僵硬,抽搐频繁,最后发展到即使无明显刺激也频繁发作,严重危及病人生命。遂于手术室中,缓慢静注安定20mg(2min推完),加压吸氧,5min后缓慢静注氯丙嗪50mg(2min推完)。10min后病人安静入睡,无抽搐。置病人侧卧位,穿刺局部常规消毒,铺无菌巾,先25号针于L_2~3间隙中线穿刺,见脑脊液流出,即将TAT4500U加生理盐水2ml注入蛛网膜下腔,缓慢推注约1min。术后病人平卧位,吸氧,测血压、脉搏、呼吸正常。1h后清醒,术后12h后病情迅速缓解,虽又抽搐2次,且每次持续时间不超过1min。24h
Patient, male, 36 years old. Three days after traumatic right foot injury, fatigue, fatigue, dizziness, convulsions with limbs several times admitted, diagnosed as systemic tetanus. After admission, symptomatic treatment such as support for 5d after not only poor efficacy, and appeared masticatory muscles, facial muscles, neck muscles, abdominal muscles, limb muscle stiffness, frequent convulsions, and finally developed to frequent attacks even without obvious stimulation, seriously endangering the lives of patients . Then in the operating room, slow intravenous stability 20mg (2min push finished), pressurized oxygen, 5min after the slow intravenous injection of chlorpromazine 50mg (2min push finished). After 10min the patient fell asleep quietly without convulsion. Set the patient’s lateral position, puncture the local routine disinfection, shop sterile towel, the first 25 needle puncture L_2 ~ 3 midline puncture, see cerebrospinal fluid outflow, about TAT4500U plus normal saline 2ml into the subarachnoid space, slowly push about 1min. Patient supine position, oxygen, blood pressure, pulse, respiration normal. After 1h awake, 12h after the disease quickly relieved, although convulsions 2 times, and each duration of no more than 1min. 24h