神经阻滞剂恶性综合征三例报道并文献复习  

Neuroleptic Malignant Syndrome: Three Cases Reports and Literature Review

作　　者：葛洪霞[1] 郑亚安[1] 马青变[1] 李姝[1] 巩燕[1] 谢蕊[1] 

机构地区：[1]北京大学第三医院急诊科,北京市100191

出　　处：《中国全科医学》2016年第3期340-342,346,共4页Chinese General Practice

摘　　要：目的提高临床医师对神经阻滞剂恶性综合征（NMS）的认识并探讨重症NMS患者的治疗策略。方法收集北京大学第三医院2008—2014年经急诊科治疗的3例NMS患者的临床资料,回顾性分析3例患者的易患因素、临床表现、实验室检查和诊治经过,并进行相关文献复习。结果 3例患者均在使用抗精神病药的过程中出现发热、意识障碍、肌强直和大汗。2例患者2~3周后才明确诊断。患者3诊断及时,经过镇静、物理降温及器官支持治疗后痊愈。结论 NMS容易被误诊和漏诊,提高对NMS的诊断意识很重要。如果使用抗精神病药的患者临床表现出感染无法解释的发热、意识障碍、肌强直、肌酸激酶升高、大汗等,要考虑到NMS。对重症NMS患者,早期充分镇静、物理降温、加强器官支持治疗是关键。Objective To improve clinicians＇ cognition on neuroleptic malignant syndrome （NMS） and explore the treatment strategies for the critically ill patients. Methods Clinical data of 3 NMS patients who were treated in the Department of Emergency of Peking University Third Hospital from 2008 to 2014 were collected. A retrospective analysis was made on the risk factors, clinical manifestations and laboratory examination and treatment process of the three patients, and relevant literatures were reviewed. Results Fever, disturbance of consciousness, myotonia and profuse sweating occurred in all the three patients when using antipsychotic drugs. Two patients weren＇t diagnosed definitely until 2 to 3 weeks after admission, and the other patient was diagnosed timely and was cured after sedation, physical cooling and organ support therapy. Conclusion The misdiagnosis and missed diagnoses are very likely to happen in the case of NMS, so it is important to improve the cognition on NMS diagnosis. If fever with unknown cause, disturbance of consciousness, myotonia, elevated creatine kinase and profuse sweating occur in patients taking antipsychotic drugs, the possibility of NMS should be considered. For patients with severe NMS, the key solutions should be early sufficient sedation, physical cooling and stronger organ support therapy.

关 键 词：安定药恶性综合征 抗交感神经药 药物毒性 

分 类 号：R971[医药卫生—药品] R742[医药卫生—药学]