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患者,男、出生2h,因全身皮肤苍白,口吐白沫2h由产科转入儿科。患儿系足日难产,早破水1h,羊水Ⅱ°污染,脐绕体2周,初评7分,生后哭声小,口吐白沫,前囱饱满,鼻扇,皮肤灰白,口周发绀,左眼球结膜片状出血,两肺可闻及湿鸣,心腹无异常。入院诊断:①新生儿肺炎,②新生儿颅内出血?③新生儿HIE。立即给抗生素、能量、止血、降压、镇静及吸氧综合治疗。入院第2天皮肤渐黄染,双下肢皮肤硬肿,入保温箱,光疗,给多巴胺4mg于10%葡萄糖50ml在输液泵中均匀静点,4滴/min。在药物进入血管内约10min,护士喂奶时发现患儿静脉穿刺部位及周围皮肤出现网状苍白,以穿刺点为中心呈放射状,伪足样沿血管走行,无液体渗出。减半输液速度,观察1min,皮肤苍白无减轻。立即停止输液,局部50%硫酸镁温湿敷,反复多次。1h后转为红色血管网,2h后皮肤颜色恢复正常。重新输注抗生素,未出现上述现象。
Patients, male, born 2h, due to body skin pale, mouth foaming at 2h from obstetrics to pediatric. Children with foot day dystocia, premature rupture of water 1h, amniotic fluid Ⅱ ° pollution, umbilical wound body for 2 weeks, the first evaluation of 7 points after birth crying small, foaming at the mouth, front chimney full, nose fan, pale skin, perioral cyanosis , The left eye conjunctiva flake bleeding, both lungs can smell and wet mute, no abnormal heart. Admission diagnosis: ① neonatal pneumonia, ② neonatal intracranial hemorrhage ③ ③ neonatal HIE. Give antibiotics, energy, hemostasis, blood pressure, sedation and oxygen therapy immediately. On the second day of hospitalization, the skin gradually yellowed, the skin of the lower extremities was swollen, into the incubator, phototherapy, to dopamine 4mg in 10% glucose 50ml in the infusion pump uniform static point, 4 drops / min. In the drug into the blood vessels for about 10min, nurse feeding found that the venous puncture site and the skin around the mesh appear pale to the puncture point as the center was radial, pseudo-foot-like walk along the blood vessels, no liquid oozing. Halved infusion rate, observed 1min, no loss of pale skin. Immediately stop infusion, local 50% magnesium sulfate temperature and humidity, repeatedly. 1h after the red vascular network, 2h after the skin color returned to normal. Re-infusion of antibiotics, did not appear the above phenomenon.