Ӱ(status epilepticus: SE)̶ 30 ̻ ӵǰų, ð ̿ ǽ ȸ ʴ 츦 Ѵ. 30 ̻ ӵȴٸ Ͽ ̴. ̷ Ǹ ӻ ϴ ǹ̰ ̴. ι° ð ̿ ǽ ȸ ʴ 츦 ӻ ϴ ̴. , ǽ ȸ ʴ´ٸ ̸ Ӱ Ǵϸ ȴ. Ӱ ġḦ Ѵ. ʿ Ӱ (diazepam) ʾ, Ÿ(ketamine) ÷ Ŀ Ǿ.
û ü˻
3.1kg 6 ȭ ũ ̰ ֵ ߴ. ǽ ¿ -뼺 Ÿ´. ǽ ȸ, 30 ̳ ٽ ۵Ǿ.
ķ ǽ ȸ ʾҰ, ħ긲 , ȣ ߴ. 躯 财 . ǽľ (lethargy), 1ð ̳ -뼺 ݺߴ. ̹ ó ߰ߵ ̾. Ǵ Ծ ɼ ߴ. ü 43.0ɱ ߰, ȣ ¿. Ǿ. ü° Ż(vital signs) ƿ 0.5mg/kg ֻߴ. 3ȸ ݺ, ʾҴ. Ȳ̴ ʸ ֻ, ʰ, 3ð . 0.9% ջĿ ӵ ߴ. 3ð ü˻ ǽ , -뼺 ݺߴ. Ⱦڼ, ȣ ߴ. ݻ ݻ ̾, ڼ ˻½ǽ . Ȱ˹ݻ ݻ ̾, ݻ(pupilary light reflex: PLR) ̾ߴ. ° ӻ, ü˻縦 ؼ 缺 ȯ Ǵ ȯ, ȯ, ǽɵǾ. 켱 缺 ȯ ϱ ؼ װ˻ ˻, 缱˻, İ˻, ˻縦 ǽߴ.
װ˻翡 ˺ι(2.1g/dl) Į(6.8mg/dl) Ǿ, AST CK(CPK), LDH Ǿ. Į ˺ιο ϸ 8.2mg/dl(=6.8+3.5-2.1) Į ƴϾ. ˻ óġ ߿ ǽϿ, 1.014 Ÿ. pH 8 Į ħ ߴ.
ι缱 ½ ̾ϰ ȮǾ. ι缱 Ư̼Ұ ʾҴ. Ŀ ڰ ߴ.
̻ ˻翡 ų 缺 ȯ Ȯε ʾҴ. ΰ ȯ ǽ߰, ߺ ̰, Ӱ ŸǷ (brain infarct), (brain hemorrhage), , ǽߴ. ̸ ؼ MRԿ ô ˻簡 ʿߴ. ˻纸ٴ ӵǾ ߴ 켱̾.
Ӱ ġ ʱ ϴ װ ̴. 0.5mg/kg ٽ ֻ ߴ, ߴ ٰ ٽ ߴ. 5 ̳ 뷮 ֻ ߰, ٷ 0.5mg/kg/hr ӵ ֻߴ. 20mg 70ml 5% 翡Ͽ 5.4ml/hr ӵ ߴ. ӵ ϱ ؼ ø ߴ. ߾ٰ 10 ̳ ٽ ۵Ǿ. Ƴ(CRI) ϸ鼭 2.5mg/kg ٺŻ(phenobarbital: PB) ֻ ߴ. Ŀ 12ð ֻߴ. ؼ װ ߴ. PB Ŀ ӵǾ Ÿ(ketamine) ߴ. 5mg/kg Ÿ õõ ֻ ߾. 5mg/kg/hr CRT ϱ 500ml 0.9% ջ Ŀ 300mg(6ml) Ÿ ÷Ͽ 25ml/hr ӵ ߴ. Ŀ ߾. 뼺 ð Ǿ, ʾҴ. DZ 10 ̻ ҿǾ. 3ð ̻ Ÿ´. Ŀ ̰, (brain edema) ݵǾ Ǵߴ. ġϱ ؼ (mannitol, 1.0g/kg 15п ļ ֻ) Ÿ(dexamethasone sodium phosphate,1mg/kg, IV) 1 ȸ ֻߴ. ֻϱ ߴ.
߰ ֻ . ʰ Ÿ Ǿ. 6ð ʾ ʺ 6ð 25% ӵ ٿ, Ÿ 12ð ʾ 4ð 25% ߴ. ų ִ ΰ ȯ(extracranial causes) Ǿ, Ǿ ΰ ȯ ã MR Կ ô ˻縦 ǽߴ. MR Կ MRI ͱ ̼ϴ ȿ ʰ Ÿ ؼ CRI ߴ. ̷ ¿ ߰ MR Կ ǽߴ. ô ȣ븦 ߰ߴ.
MRԿ T1 ū ȭ ã . ܸ ̾ϰ йڵǴ Ұ Ǿ. T2 ĵοʿ Ǿ ̾ Ұ Ǿ. ʾҴ. ô ˻翡 Ѵܹ 137mg/dl , ټ 6cells/l ̾. 2,021cells/l ߴ. ˻翡 ټ Ǿ, Ҽ ȣ߱ Ǿ. ٱ Ȱȭ ٱ (activated monocytoid cells) κ̾. ʾҴ. ô ˻翡 (༺ ȯ) , ܻ Ǵ ǽ Ǿ. ߴµ, ̴ ô ȥԵ ε ִ. ȥ ȣ߱ Ե ټ Ǿ, Ѵܹ ̴.
ô ִ(2, 3). ġ MR Կ ֺ Ǿ MR Կ ĺ ġḦ ߴ. 0.5g/kg 24ð 6ð ֻ ߰, Ŀ ȸ 12ð ֻ ߴ. 1mg/kg Ǫμ̵(furosemide) 24ð 6ð ֻ ߰, Ŀ 8ð ֻߴ. 30mg/kg MPSS 1ȸ ֻ ߰, 24ð 1mg/kg ϼַ 12ð ֻߴ. Ŀ 12ð 0.5mg/kg ϼַ ֻ߰, ߴ. Ÿ Ŀ ǽ ȸ߰, ʾҴ. ߴ. Կ 3° ǽ Ȯ, Ŀ ̾.
(ataxia) Ǿ. PB ߵ ɼ ֱ ؼ 12ð ֻ߰, Կ 5° 汸 ȯߴ. 2 PB ߳ Ͽ 뷮 ̴. Ӱ ȯ ߰, ð Ϳ ɼ . ġ ̴. 2 ߰ MR ô ˻縦 ǽѴٸ ĸ ̴.
ʿ CRI ߴµ ʾ Ÿ ߴ. ̷ Ӱ Ǿ, ġ Բ Կ 2° ̻ ʾҴ.
ʱ PB Ͽ뷮 ʾҰ, 뷮 ߴ. PB Ͽ뷮 Ǿ ǹ̴. ٸ ʿ ̸ õغ ʿ䰡 ִ. Ӱ ġ ϳ װ ٸ ȯϴ ߴ. ϰ, ̾ϰų ȶ 찡 Ҵ . װ ֻ縶 輺 ƴ, ϸ ۿ ũų, ü Ƿ õϴ ͵ ǹ̰ ִٰ Ѵ.
ʴ 24ð ʰ Ÿ ߴµ ʾҴ. Ӱ (brain infarct)̶ ȣ װ ִ. MR ĵο ũ Ŀ Ÿ ̴. װ ̴