高血压脑出血后发作性自主神经功能不稳伴肌张力障碍  

Paroxysmal autonomic instability with dystonia after hypertensive intracerebral hemorrhage

作　　者：刘斌[1] 王勇[2] 骆健明[1] 郭燕春[1] 谢泽宇[1] 张增良[1] 

机构地区：[1]汕头大学医学院第二附属医院神经外科 [2]河南省人民医院神经外科

出　　处：《中华临床医师杂志（电子版）》2012年第2期22-25,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨高血压脑出血后发作性自主神经功能不稳伴肌张力障碍(PAID)的临床特点、发病机制和治疗。方法报道3例高血压脑出血后PAID病例,并结合文献进行分析。结果男性2例,女性1例,年龄35～48岁,脑出血前有高血压病史2～9年,脑出血后6d内出现PAID。3例患者均经历了发热、心动过速、呼吸急促、多汗、肌张力障碍,2例患者有躁动和难以控制的高血压。不同的药物单独或联合应用以缓解PAID。脑出血后6个月根据GOS评分:重残、植物生存、死亡各1例。结论当高血压脑出血患者出现发热、心动过速、呼吸急促、多汗、肌张力障碍等症状时,PAID的诊断应该考虑。治疗前应确认触发PAID的因素并给予解除,药物治疗包括镇静剂、阿片受体激动剂、β受体阻断剂和中枢神经抑制剂等。Objective To study the clinical characteristics, the pathogenesis and the management of paroxysmal autonomic instability with dystonia （ PAID ） after hypertensive intracerebral hemorrhage. Methods To report three clinical cases with PAID after hypertensive cerebral hemorrhage and to review literatures. Results Therewere two male patients and a famale one, aged from 35 to 48, with 2 to 9 years history of hypertension before cerebral hemorrhage. The onset of PAID oeeured in the first week after intracerebral hemorrhage. All 3 patients presented with pyrexia,taehyeardia, tachypnea, diaphoresis, dystonia, and two of them suffered from agitation and uncontrollablehypertension. Various drugs had been used singly or in combination to alleviate PAID. Six months after intracerebral hemorrhage, the final outcome in patients was, according to GOS categories, that severe disability, vegetative state and death were obtained in 1 case respectively. Conclusions Within the clinical setting of hypertensive hemorrhage,thediagnosis of PAID should be taken into consideratiom when a patient comes with the symptom of pyrexia, tachycardia, tachypnea, diaphoresis, dystonia, and so on. These clinical features are, however, shared with several other medical conditions which should be ruled out before making a diagnosis. We should identify the noxious triggering factors of k PAID and resolve them before management; pharmacologic treatment includes sedative, opiate receptor agonists, β- blochers, and central nervous system depressants.

关 键 词：高血压 脑出血 发作性自主神经功能不稳伴肌张力障碍 

分 类 号：R743.34[医药卫生—神经病学与精神病学]