Pulmonary oedema during treatment of acute water intoxication.

Acute water intoxication with deepening coma and uncontrolled epileptiform seizures in a 25-year-old previously fit male schizophrenic was treated with hypertonic (2 N) saline and a 20% mannitol solution. This improved his neurological state but precipitated severe pulmonary oedema. Intravenous frusemide increased his urinary output sufficiently to clear the pulmonary oedema. In acute water intoxication the use of hypertonic solutions may thus precipitate left heart failure by expanding the intra-pulmonary blood volume beyond the capacity of even a healthy left ventricle to compensate. Simple water restriction will produce a slower but perhaps safer improvement.     

Intoxication caused by interaction of chloramphenicol and phenytoin

A patient with a brain tumor and seizures who was receiving maintenance doses of phenytoin was given chloramphenicol on three occasions. Her neurological status was both complicated and obscured by the reoccurrence of phenytoin intoxication. Retrospective drug analysis showed a marked elevation of serum concentrations of phenytoin during each course of chloramphenicol.     

Treatment of hyponatraemic seizures with intravenous 29.2% saline

Five patients with severe hyponatraemia and epileptiform seizures were given 50 ml of 29.2% saline (250 mmol) through a central venous catheter over 10 minutes to control seizures rapidly, reduce cerebral oedema, and diminish the incidence of permanent neuronal damage. The saline controlled seizures in all patients, increasing the mean serum sodium concentration by 7.4 (SD 1.14) mmol(mEq)/l and decreasing the mean serum potassium concentration by 0.62 (0.5) mmol(mEq)/l. Further saline and frusemide were then administered over 10 (2) hours, raising the serum sodium concentration by 2.14 (0.49) mmol/l/h until it reached 133 (2.35) mmol/l. A total of 790 (139) mmol saline was infused and a negative fluid balance of 3.34 (0.75) litres achieved. Four patients survived without neurological abnormality. One patient, who was not treated immediately and suffered a prolonged episode of status epilepticus, was left with a permanent neurological defect.     

高渗盐水和20%甘露醇治疗急性脑血管病的疗效对比

目的探讨高渗盐水和20%甘露醇治疗急性脑血管病的疗效,以供临床参考。方法将我院63例急性脑血管疾病的患者随机分为2组。I组患者给予3%的高渗盐水治疗,II组患者给予20%甘露醇治疗,比较2组患者治疗后的神经功能缺失情况及患者肾功能和电解质变化。结果 I组患者无肾功能损害,血清电解质变化不明显。II组患者出现肾功能损害,电解质无变化。2组患者神经功能缺损均改善。结论 3%的高渗盐水资料急性脑血管病能取得较好的疗效,对患者肾脏功能无损害,是一种安全有效的治疗药物。     

早期应用地塞米松预防大鼠桥脑中央髓鞘溶解症的发生

目的：探讨地塞米松（DEX）对大鼠中央髓鞘溶解症（CPM）的预防作用及机理。方法：通过皮下注射长效尿崩停针和腹腔注射2．5％葡萄糖液诱导大鼠低钠血症3d，第4天腹腔注射1mol／L氯化钠液（高渗盐水）快速补钠的方法诱导大鼠CPM模型。DEX早期治疗组大鼠在注射高渗盐水同时肌注5mg／kg DEX；DEX延迟治疗组大鼠在注射高渗盐水后24h肌注5mg／kg DEX；生理盐水治疗组大鼠在注射高渗盐水同时肌注生理盐水；另设正常对照组。观察大鼠脑组织脱髓鞘病变发生情况；测定脑内伊文思兰（EB）的含量变化；Western blot印迹法测定脑内一氧化氮合酶（iNOS）的表达变化。结果：通过诱导低钠血症、快速补钠的方法成功建立了大鼠CPM模型。DEX早期治疗组、DEX延迟治疗组、生理盐水治疗组3组大鼠在快速补钠后0h时点，脑内EB含量与正常对照组无明显差异（P〉0．05）。生理盐水治疗组大鼠在快速补钠后6h，脑内EB含量比0h时点明显增加（P〈0．05），24h达高峰，同时脑内iNOS在快速补钠后3h开始表达增强，36h仍呈较强表达，脱髓鞘发生率为66．7％。DEX早期治疗组大鼠快速补钠后脑内EB含量及iN0s表达，均较同时点生理盐水治疗组明显下降，未见明显脱髓鞘病变。DEX延迟治疗组脱髓鞘病变发生率为75％，与生理盐水治疗组无明显差异（P〉0．05）。结论：早期应用DEX能够通过保护血脑屏障和抑制脑内iNOS表达，起到预防CPM的作用。     

Hypernatraemic dehydration after Lucozade.

OBJECTIVE: To emphasise the dangers of inappropriate rehydration fluids in the treatment of gastroenteritis. CLINICAL FEATURES: A two-year-old girl was admitted to hospital in shock and unconscious. She had a 36-hour history of diarrhoeal illness and had received Lucozade. Therapy with this hypertonic fluid resulted in worsening diarrhoea and seizures. On examination she had hypernatraemic dehydration and decorticate posturing. INTERVENTION AND OUTCOME: An intravenous line was inserted, stable plasma protein solution was given, and she was admitted to the intensive care unit. Anticonvulsant and antibiotic therapy were begun. Significant neurological impairment was still evident after 14 days, at which time shw was discharged from hospital. Six months later she had made a good recovery, with no persisting neurological deficit. CONCLUSION: The inappropriate use of hypertonic fluids in gastroenteritis may be associated with significant electrolyte imbalances and neurological sequelae.     

Paradoxical seizures in phenytoin toxicity

Phenytoin toxicity is an uncommon problem seen in clinical practice. The predisposing factors for toxicity are hypoalbuminemia, chronic renal failure, hepatic dysfunction and drugs which interfere with phenytoin metabolism. Common manifestations of toxicity, like confusion and ataxia, are well known. A less well known phenomenon is paradoxical seizures. In this condition, seizures develop as the serum phenytoin level rises and decrease in frequency as levels drop. It may or may not be accompanied by other features of toxicity. We present three patients with paradoxical seizures; their serum phenytoin levels were 43.5 mcg/mL, 46.5 mcg/mL and 38.3 mcg/mL. In all cases, seizures were controlled by withdrawal of phenytoin and reduction of drug levels.     

高渗盐水支气管激发试验测定气道反应性

作者报告用超声雾化器吸入高渗盐水(HS)测定11例哮喘患者的气道高反应性。吸入HS浓度为NaCl 462～1231mmol/L,以FEV_1-PC_(20)作为气道反应性的判定指标。试验结果,11例哮喘患者中10例呈阳性反应,HS-PC_(20)为477～1037mmol/L。作者认为此法简易,敏感性较高,副作用小,便于临床应用。     

高渗盐对急性氨中毒大鼠脑效应的限灌注成像研究

目的研究高渗盐对急性氨中毒情况下大鼠脑MR灌注成像的NEI，MSD和MTT值的影响，进而揭示高渗盐对急性氨中毒大鼠脑灌注的影响。方法24只大鼠随机（数字表法）分为生理盐水组、高渗盐组、氨＋生理盐水组、氨＋高渗盐组，每组6只。其中氨＋生理盐水组、氨＋高渗盐组的12只大鼠均以腹腔注射醋酸铵造成急性氨中毒；然后6只急性氨中毒大鼠通过股静脉滴注23．4％高渗盐溶液；另6只急性氨中毒大鼠通过股静脉滴注相同剂量生理盐水作为对照。另两组生理盐水组、高渗盐组只通过股静脉滴注23．4％高渗盐溶液或生理盐水，15min滴完，作为对照；之后马上进行MR成像。原始图像传送至工作站（AdvantageWorkStati0nAW4．0-0.5，GE公司），采用FL1nctiontool灌注软件处理，分别获得NEI、MSD和MTT参数图，选取尾壳核、运动皮层，感觉皮层，丘脑及小脑实质为兴趣区（ROI），分别测得双侧上述ROI的NEI、MSD、MTT值，然后取双侧小脑（Cb）实质均值，并分别计算上述左侧或右侧兴趣区（R0I）与之的比值，得到相对NEI、MSD和MTT（rNEI、rMSD及rMTT），然后四组进行比较。结果左侧尾壳核区的rNEr值氨＋高渗盐组及高渗盐组低于氨＋生理盐水组，具有统计学意义；右侧尾壳核区的rNEI值氨＋生理盐水纽较其他三组均高，且具有统计学意义：而其他各脑区rNEI值及各组rMTT及rMSD值比较均无明显差异。结论急性氨中毒大鼠尾壳核区存在充血变化，高渗盐溶液输注后可引起尾壳核区的rNEI值降低，表明高渗盐溶液可缓解大鼠急性氨中毒后尾壳核区高灌注状态，所以高渗盐可以缓解急性氨中毒大鼠脑高灌注，有利于脑水肿缓解。     

Which drug for the adult epileptic patient: phenytoin or valproate?

A series of 140 previously untreated patients with tonic-clonic or partial seizures were randomised to receive either phenytoin or sodium valproate. There was no difference between the treatment groups in pretreatment variables that might influence outcome. Sodium valproate and phenytoin in the treatment of tonic-clonic or partial seizures showed no difference in efficacy as regards time to two year remission or time to first seizure. When the possible prognostic factors were studied, including history and results of clinical examination and investigations before treatment; the only factor which influenced the proportion of patients achieving two year remission was type of seizure. Patients with a clinical history of partial seizures did significantly less well than those with a history of tonic-clonic seizures only. This study showed no major difference in efficacy between sodium valproate and phenytoin in adults with recent onset of epilepsy, irrespective of the type of seizures that the patient suffered.     

3%高渗盐水联合普米克令舒雾化吸入治疗毛细支气管炎疗效观察

目的:探讨3%高渗盐水联合普米克令舒氧气雾化吸入治疗毛细支气管炎的疗效。方法:将58例毛细支气管炎住院患儿随机分为治疗组与对照组,治疗组32例,对照组26例。全部病例均给予改善通气、氧疗、抗感染、化痰、止咳、镇静、吸入硫酸沙丁胺醇平喘、纠正水电解质酸碱失衡等常规综合治疗,对照组加用盐酸氨溴索联合地塞米松雾化吸入,治疗组给予3%高渗盐水联合普米克令舒氧气雾化吸入,观察两组临床症状:喘憋、气促、发热、咳嗽、肺部体征持续时间、住院时间及不良反应。结果:治疗组临床症状、肺部体征持续时间、住院时间明显短于对照组,差异有统计学意义(P<0.01),总有效率明显高于对照组,差异有统计学意义(χ2=6.37,P<0.05)。结论:3%高渗盐水联合普米克令舒雾化吸入治疗毛细支气管炎,疗效确切,能有效控制毛细支气管炎症状及体征,缩短病程,提高治愈率,治疗安全、有效、操作简便。     

交替使用高渗盐水和甘露醇治疗缺血性脑梗死的疗效观察

目的:探讨交替使用甘露醇和高渗盐水对缺血性脑梗死患者的脱水治疗效果,以期在降低颅内压的同时,减少不良反应的产生。方法:将缺血性脑梗死患者随机分为实验组和对照组,实验组采用甘露醇和高渗盐水交替应用的脱水方法,对照组单纯使用甘露醇。观察两组治疗前、后患者的神经功能评分、血电解质浓度和肾功能。结果:经14d的脱水治疗后,两组患者的神经功能评分均显著改善,其中实验组的评分稍优于对照组,但差异无统计学意义(P>0.05)。治疗期间,两组的血Na+,Cl-,K+,Ca++浓度均无显著性变化;但对照组的血肌酐和尿素氮浓度则呈明显进行性升高,而实验组则升高幅度较小。在治疗的第5天和第10天,实验组的肌酐和尿素氮浓度均显著低于对照组(P<0.01)。结论:交替使用高渗盐水和甘露醇对缺血性脑梗死有较好的脱水治疗效果,同时其肾毒性较单纯应用甘露醇明显减少。     

高渗盐水支气管激发试验及痰诱导在慢性咳嗽中的临床应用

目的 观察高渗盐水支气管激发试验及痰诱导在慢性咳嗽诊断和治疗中应用的可行性及不良反应,探讨其临床应用价值.方法 按照咳嗽的诊断与治疗指南进行诊断,对于不能确诊的38例慢性咳嗽患者进行高渗盐水支气管激发试验及痰诱导检测.结果 38例慢性咳嗽患者,其中23例支气管激发试验阳性,第1 s用力呼气容积(FEV1)下降27%±5.8%,诊断咳嗽变异型哮喘(23/38,60.5%),3例出现不良反应,发生率为7.8%.痰诱导检测中,24例(24/38,63.2%)患者嗜酸性粒细胞(EOS)增高9.8%±4.8%,其中包括17例咳嗽变异型哮喘患者,7例支气管激发试验阴性患者诊断嗜酸粒细胞性支气管炎(7/38,18.4%).15例EOS增高患者完成随访,激素治疗后EOS百分比显著下降为4.6%±2.1%,治疗前后比较差异有统计学意义.结论 高渗盐水支气管激发试验同时进行痰诱导检测可行性好、不良反应发生率低,在慢性咳嗽病因诊断及治疗中显得极为重要.     

Lack of efficacy of phenytoin in the syndrome of inappropriate anti-diuretic hormone secretion of neurological origin

Phenytoin has been proposed in the management of patients with the syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) of neurological origin who fail to respond to water restriction. We have conducted a prospective study in order to evaluate the role of phenytoin in the management of seven consecutive patients with SIADH of neurological origin which could not be controlled by limited water intake. Only one patient was successfully treated with chronic phenytoin regimen. This patient, like one previously reported, had suffered a basal skull fracture. It seems likely that in the majority of cases of SIADH of neurological origin phenytoin is ineffective on a long-term basis.     

高渗盐水对慢性鼻窦炎患者鼻腔黏膜纤毛清除功能的影响

目的:探讨高渗盐水对成年慢性鼻窦炎患者鼻腔黏膜纤毛运动功能的影响。方法:选取住院待行鼻内窥镜下慢性鼻窦炎手术的患者为研究对象,用鼻腔黏膜纤毛清除功能糖精清除率法检测正常状态、鼻腔生理盐水喷雾和高渗盐水喷雾后糖精清除时间,统计学方法采用Wilcoxon检验。结果:慢性鼻窦炎患者平均糖精清除时间为19.62 min,生理盐水和高渗盐水冲洗后患者平均糖精清除时间分别为17.74 min和13.22 min。与冲洗前相比,生理盐水未明显加快糖精清除速度(P>0.05),而高渗盐水冲洗后患者平均糖精清除时间明显缩短(P<0.01),平均缩短6.4 min。结论:高渗盐水可使慢性鼻窦炎患者的黏膜清除时间缩短,促进黏膜的清除功能。等渗生理盐水对黏膜清除时间影响不明显。     

Febrile seizures in young children: role of fluid intake and conservation.

Febrile seizures are a common occurrence in young children with incidence rates varying from 3-14%, depending on the geographic region. Studies have suggested that an elevated temperature is a factor in their development, though other factors may synergistically lower the seizure threshold. While it is recognized that excessive or rapid dilute fluid intake can cause seizures in young children, and in adults during strenuous physical activity, less focus has been paid to its involvement during febrile illnesses. Young children are more vulnerable to the development of febrile seizures due to their small skull size relative to brain volume. In animals, reduced serum sodium levels have been shown to lower the threshold to convulsive stimuli, while hypertonic saline has been shown to rapidly reverse these effects. Similarly vasopressin, frequently elevated during acute infections, enhances fluid retention and may also be a precipitating factor for febrile seizures. Although an elevated temperature may augment seizure risk, antipyretics have not been shown to prevent them. In fact, some may increase seizure risk through a reduction in urine output. It has long been observed that fluid retention occurs during febrile infections, followed by diuresis during convalescence. This characteristic observation led to recommendations for restricted fluid intake during acute infections dating back more than 2,000 years. Only recently has there been a return to restricted fluid intake for patients with potentially reduced free water excretion. Further studies are required to determine the role of the overall fluid balance in the etiology of childhood febrile seizures.     

鼻内镜术后高渗盐水鼻腔冲洗的应用

目的探讨鼻内镜术后高渗盐水鼻腔冲洗的疗效及应用价值。方法将100例慢性鼻窦炎、鼻息肉患者随机分为两组,治疗组50例采用高渗盐水冲洗液行鼻内镜术后鼻腔冲洗;对照组50例采用0.9%生理盐水加庆大霉素8万U和地塞米松10mg冲洗,随访6个月,观察、比较两组的疗效及术后术腔上皮化时间。结果治疗组疗效优于对照组(P=0.008)。术腔上皮化时间早于对照组(P=0.000)。结论高渗盐水冲洗液在慢性鼻窦炎鼻息肉鼻内镜术后应用具有减轻术腔水肿、缩短术腔上皮化时间、促进术腔愈合及无副作用的优点,值得临床应用推广。     

乌司他丁联合高渗盐水对肝脏缺血再灌注损伤的影响及作用机制的实验研究

目的探讨乌司他丁联合高渗盐水预处理对大鼠肝脏缺血再灌注损伤的保护作用及作用机制。方法60只健康雄性SD大鼠,体重230g左右,随机分为五组,每组12只:假手术组(A组)、缺血再灌注组(B组)、乌司他丁预处理组(C组)、高渗盐水预处理组(D组)和乌司他丁联合高渗盐水预处理组(E组)。采用Pringle法分别建立大鼠肝脏缺血再灌注模型,观察肝脏缺血30min再灌注6h后血清中谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)和肿瘤坏死因子-α(TNF-α)含量并观察肝组织病理学改变。结果B、C、D和E组血清中ALT、AST、LDH和TNF-α含量明显高于A组(P<0.05);C、D和E组明显低于B组(P<0.05);C组和D组明显高于E组(P<0.05);C组和D组之间差别无统计学意义(P>0.05)。肝组织病理学损害B组最重,C、D组次之,E组轻于C、D组。结论乌司他丁、高渗盐水预处理对大鼠肝脏缺血再灌注损伤具有保护作用,二药联用效果更好。     

Bronchial hyperreactivity in response to inhalation of ultrasonically nebulised solutions of distilled water and saline

To assess non-specific bronchial reactivity the effect of inhaling ultrasonically nebulised solutions of distilled water and hypotonic (0.3%), isotonic (0.9%), and hypertonic (2.7%, 3.6%) saline was investigated in 10 asthmatic patients and nine normal subjects. Expired ventilation and the maximum percentage fall in forced expiratory volume in one second (FEV1) were recorded. The sensitivity to the inhaled solutions was determined by measuring the ventilation required to induce a fall in FEV1 of 20% from the prechallenge value. Hypotonic and hypertonic but not isotonic solutions caused a significant fall in FEV1 in the asthmatic subjects. Normal subjects showed no response to either distilled water or 3.6% saline, the only solutions with which they were challenged. The method used for this challenge is rapid, simple, and inexpensive and provides a new means of diagnosing non-immunologically mediated bronchial hyperreactivity.     

不同浓度盐水雾化吸入治疗毛细支气管炎临床观察#br#

目的：比较不同浓度盐水雾化吸入治疗毛细支气管炎住院患儿的临床疗效、安全性及其经济性。方法：纳入2012年1月至12月本院儿童呼吸科的毛细支气管炎住院患儿共66例,用随机数字表将患者分成3组,分别为0.9% NaCl组、3% NaCl组、5% NaCl组,分别给予0.9% NaCl液3 mL、3% NaCl液3 mL、5% NaCl液3 mL雾化吸入。采用空气压缩雾化器与面罩吸入,入院12 h内接受治疗每天3次（早上、中午、晚上,间隔4 h以上）直至出院。主要观察指标包括临床严重度评分（CBSS）、住院时间、不良事件发生率及住院费用。结果：各组毛细支气管炎患儿入院第1～第3天的临床严重度评分（CBSS1、CBSS2、CBSS3）、住院时间、临床症状缓解时间等比较,差异无统计学意义（P＞0.05）。5% NaCl组不良事件发生率为12.2%,显著高于0.9% NaCl组（为2.3%）和3% NaCl组（为4.6%）,差异有统计学意义（x2=34.199,P＜0.01）。不良事件主要包括雾化过程中出现普通咳嗽、剧烈咳嗽和呕吐。结论：毛细支气管炎住院患儿治疗中应用高渗盐水（3% NaCl液、5% NaCl液）与0.9% NaCl液雾化吸入的疗效相当且未增加医疗费用;3% NaCl液雾化吸入的安全性较5% NaCl液好,但两者均未出现明显严重不良事件。