长期口服苯妥英钠导致严重精神行为异常分析  

Analysis of Severe Mental and Behavioural Disorder Due to Long-term Oral Administration of Phenytoin Sodium

作　　者：余立丹 李海江[1] 安义均 杨丹[1] 陈涛[1] YU Li-dan;LI Hai-jiang;AN Yi-jun;YANG Dan;CHEN Tao(Department of Neurology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Graduate School,Kunming Medical University,Kunming 650500,China)

机构地区：[1]昆明医科大学第一附属医院神经内科,昆明650032 [2]昆明医科大学研究生院,昆明6505002

出　　处：《临床误诊误治》2018年第3期89-91,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨苯妥英钠中毒的临床表现、诊断及治疗。方法回顾性分析我院收治的长期口服苯妥英钠致严重精神行为异常1例的临床资料。结果本例因步态不稳、视物成双、幻听3月余,间断意识障碍2个月急诊入院。诊断癫痫10年,长期口服苯妥英钠100 mg、3/d,症状基本控制,3年前症状加重自行加量至200 mg、3/d,期间出现神经症状后停药。此次因癫痫发作再次加量至200 mg、3/d,入院后依据临床症状、体征及医技检查结果,明确诊断为苯妥英钠中毒导致严重精神行为异常,遂停用苯妥英钠并加用丙戊酸钠、托吡酯治疗,同时予营养神经、利尿、叶酸等支持治疗,精神症状缓解,病情好转出院。结论苯妥英钠中毒临床症状无特异性,提高认识并定期监测血药浓度是避免或减少误诊的关键。Objective To investigate the clinical manifestations,diagnosis and treatment of Phenytoin sodium poisoning.Methods A retrospective analysis was performed on clinical data of 1 patient with severe mental and behavioral disorder caused by long-term use of oral Phenytoin sodium in our hospital.Results The patients was admitted in emergency due to unsteady gait,diplopia,auditory hallucinations for three and a half months,and intermittent consciousness disorders for 2 months.He was diagnosed with epilepsy 10 years ago,which was under control by long-term oral administration of phenytoin of 100 mg three times a day.The dosage was increased to 200 mg three times a day by himself 3 years ago when symptoms were aggravated.Phenytoin was withdrawn when he developed neurological symptoms.The dosage was increased to 300 mg three times a day due to epileptic seizures.According to the clinical symptoms,signs and medical examination results,he was diagnosed as having severe mental&behavioral disorder caused by Phenytoin poisoning.Thus,Phenytoin was discontinued,and he was treated with Sodium Valproate and Topiramate,and given supportive treatment,such as neurotrophic drugs,diuretic,and folic acid.As psychiatric symptoms were relieved,he was discharged from hospital.Conclusion Given non-specific symptoms of Phenytoin sodium poisoning in clinical settings,it is key to raise awareness and monitor plasma concentration regularly,thereby avoiding or reducing misdiagnosis.

关 键 词：中毒 癫痫 强直阵挛性 精神治疗药物 

分 类 号：R595.9[医药卫生—内科学]