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为认真做好暴发型流脑(以下简称暴脑)的抢救工作,提高抢救质量,现就四例抢救工作中发现的几个问题简单报告如下。一、磺胺嘧啶引起急性肾功能衰竭: 例1.×××,男,16岁,诊断:暴发型流脑(休克型)。入院后按休克型常规抢救,于14小时后休克回逆,第二天神志清楚,循环呼吸功能良好。用磺胺嘧啶、氯霉素治疗。第三天开始头痛呕吐加重,体温39℃,尿少。误认抗菌不力,第四天又静滴磺胺嘧啶6克,下午再度进入昏迷,呕咖啡色胃内容,柏油样大便一次,尿检:蛋白(++)、管型(++)、红细胞和磺胺嘧啶结晶满视野,CO_2结合力20容积％,N.P.N120毫克％,遂诊断急性肾功能衰竭。立即停用磺胺嘧啶,改青霉素、氯霉素控制感染,严格限制入水量,静脉点滴硷性液、利尿合剂和对症处理。第五天,尿量约500毫升,症状减轻。第六天,清醒,尿量约700毫
In order to conscientiously do a good job in salvaging the outbreak of fulminant meningitis (hereinafter referred to as “violent brain”) and in improving the quality of rescue, several issues discovered in the rescue work of the four cases are briefly reported as follows. First, sulfadiazine caused acute renal failure: Example 1. × × ×, male, 16 years old, diagnosis: fulminant meningitis (shock type). After admission by shock conventional rescue, shock back in 14 hours after the inverse, the next day clear consciousness, circulatory function is good. With sulfadiazine, chloramphenicol treatment. The third day began to aggravate headache vomiting, body temperature 39 ℃, oliguria. Mistaken for antibacterial ineffective, the fourth day and intravenous sulfadiazine 6 grams, afternoon into the coma again, vomit brown stomach content, tarry stool, urine test: protein (++), tubular (++), red blood cells and sulfadiazine Crystallization full field of view, CO 2 binding force of 20 volume%, NPN120 mg%, then the diagnosis of acute renal failure. Immediate withdrawal of sulfadiazine, penicillin, chloramphenicol control of infection, strictly limit the amount of water, intravenous alkaline solution, diuretic mixture and symptomatic treatment. The fifth day, urine output of about 500 ml, reduce the symptoms. The sixth day, awake, urine output of about 700 milliliters