岚哥岚嫂说病例第2季第08期（病例部分）

An 18-month-old baby girl presents to the emergency department (ED) with a fever.Her parents state that the patient has had a cough and rhinorrhea for the past 24 hours. She also has a decreased appetite and has been fussy. She had been afebrile until this morning, when she appeared flushed and uncomfortable and had a temperature of 40℃. In the ED, the patient begins to have generalized tonic-clonic movements of her face, neck, and extremities for 1 minute. She is conscious but drowsy immediately after the seizure. Her temperature is 40.5℃, respiratory rate is 24/min, pulse is 120/min, and blood pressure is 100/54 mmHg. Her pupils are round and equally reactive to light. Her mucous membranes are moist, and her pharynx is mildly erythematous. She is able to move her extremities spontaneously and has normal tone throughout. Kernig’s and Brudzinski’s signs are absent. The patient has no prior history of seizures.

Which of the following is the most appropriate next step in management?
(A) Acetaminophen
(B) Electroencephalogram
(C) Lumbar puncture
(D) Phenobarbital
(E) Valproic acid

这次病例的主角是一名18个月大的女婴，她因为发热被送到急诊室。她的父母主诉她在过去24小时里一直在咳嗽和流涕，也出现了食欲减退和挑食的问题。当她出现面色潮红和不适时，体温为40摄氏度并一直惊厥至当天早上。在急诊室，患儿出现面部、颈部、四肢的全身强直-阵挛发作，并持续了1分钟。患儿原先意识清醒，但是在癫痫之后立即呈嗜睡状态。这时的生命体征是：体温40.5摄氏度，呼吸频率24次/分，脉搏120次/分，血压100/54 mmHg。瞳孔等大等圆对光灵敏。她的黏膜湿润，眼部有轻微的红斑。能自己以正常的幅度活动四肢。但是患者克尼格征和布鲁金斯征呈阳性。父母没有癫痫史。

那么接下来最恰当的治疗是什么？请说出理由。
A.扑热息痛
B.脑电图
C.腰穿
D.苯巴比妥
E丙戊酸