多巴丝肼与奥氮平及氯丙嗪合用致抗精神病药恶性综合征  

Neuroleptic malignant syndrome associated with concomitant use of levodopa and benserazide hydrochloride, olanzapine, and chlorpromazine

作　　者：王海飞 

机构地区：[1]南京市高淳人民医院药剂科,211300

出　　处：《药物不良反应杂志》2015年第1期67-68,共2页Adverse Drug Reactions Journal

摘　　要：1例71岁男性帕金森病患者应用多巴丝肼（0.25 g,2次/d口服）治疗2年,因出现脑器质性精神障碍加用奥氮平2.5 mg,2次/d口服.第3天因患者出现兴奋躁动,肌内注射氯丙嗪50 mg.第5天患者出现发热（38.8℃）、肌酸激酶升高（424 U/L）、四肢肌强直.第11天患者体温39.2℃,出现木僵状态,尿液呈酱油样.实验室检查：外周血白细胞计数9.5× 109/L,中性粒细胞0.9,肌酸激酶939 U/L.诊断为抗精神病药恶性综合征.停用奥氮平和多巴丝肼,给予纳洛酮、中/长链脂肪乳、复方氨基酸、肠内营养混悬液及地塞米松对症支持治疗.第13天,患者体温恢复正常.第15天,患者肌酸激酶降至109 U/L.第17天恢复多巴丝肼治疗.A 71-year-old man with Parkinson’ s disease received levodopa and benserazide hydrochloride 0.25 g twice daily for two years.Olanzapine 2.5 mg twice daily was added to his regimen for brain organic mental disorders.On day 3,the patient developed agitation and received an intramuscular injection of chlorpromazine 50 mg.On day 5,he developed temperature of 38.8 ℃,elevated serum creatine kinase （424 U/L）,and muscle rigidity.On day 11,he presented with temperature of 39.2 ℃,stupor,and soy-colored urine.Laboratory tests showed the following findings：white blood cell count 9.5 ×10^9/L,neutrophile granulocyte 0.9,and creatine kinase 939 U/L.Neuroleptic malignant syndrome was diagnosed.Olanzapine and levodopa and benserazide hydrochloride were withdrawn.Meanwhile symptomatic and supportive treatments such as naloxone,medium and long chain fat emulsion,compound amino acid,enteral nutritional suspension,and dexamethasone were given.On day 13,his body temperature returned to within normal range.On day 15,the creatine kinase level decreased to 10^9 U/L.On day 17,levodopa and benserazide hydrochloride was resumed.

关 键 词：左旋多巴 苄丝肼 奥氮平 氯丙嗪 安定药恶性综合征 

分 类 号：R742.5[医药卫生—神经病学与精神病学]