Beards S C, Lipman J, Bothma P A, Joynt G M
Intensive Care Unit, Baragwanath Hospital and Department of Anaesthesia, University of Witwatersrand, Johannesburg.
S Afr J Surg. 1994 Mar;32(1):33-5.
A patient with severe tetanus, who had a sympathetic crisis while sedated with 30 mg/h diazepam and 30 mg/h morphine, is described. Satisfactory control of the haemodynamic crisis was achieved with bolus doses of esmolol to a total of 180 mg. A disturbing finding was that although there was adequate control of the tachycardia and hypertension, arterial catecholamine levels remained markedly elevated. Adrenaline levels of 531 pg/ml (normal 10-110 pg/ml) and noradrenaline levels of 1,036 pg/ml (normal 100-500 pg/ml) were recorded when the patient had a systolic arterial pressure of 110 mmHg and a heart rate of 97/min. The implications of this finding are discussed.
本文描述了一名患有严重破伤风的患者，在接受30毫克/小时地西泮和30毫克/小时吗啡镇静时发生了交感神经危象。通过静脉推注艾司洛尔，总量达180毫克，实现了对血流动力学危象的满意控制。一个令人不安的发现是，尽管心动过速和高血压得到了充分控制，但动脉儿茶酚胺水平仍显著升高。当患者收缩压为110毫米汞柱、心率为97次/分钟时，测得肾上腺素水平为531皮克/毫升（正常范围10 - 110皮克/毫升），去甲肾上腺素水平为1036皮克/毫升（正常范围100 - 500皮克/毫升）。本文讨论了这一发现的意义。
