高龄帕金森病患者腹部手术继发恶性综合征 横纹肌溶解 急性肾损伤一例并文献复习  

Malignant syndrome,rhabdomyolysis and acute renal injury following abdominal surgery in advanced-aged patients with Parkinson's disease:a case report and literature review

作　　者：王艳[1] 潘明鸣[1] 乔力松[1] 杨继红[1] 范芸[1] 阿达克 方保民[1] Wang Yan;Pan Mingming;Qiao Lisong;Yang Jihong;Fan Yun;A Dake;Fang Baomin(Department of Respiratory and Critical Care Medicine,Department of Health Care,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]北京医院呼吸与危重症医学科,保健医疗部,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中华老年医学杂志》2021年第5期576-579,共4页Chinese Journal of Geriatrics

基　　金：北京医院科技新星项目(BJ-2016-036);国家自然科学基金(81300033)。

摘　　要：目的加深对高龄帕金森患者腹部手术后继发恶性综合征及横纹肌溶解、急性肾损伤的认识。方法本文报道1例我科救治的85岁高龄帕金森患者腹部手术后发生恶性综合征、横纹肌溶解、急性肾损伤的病例,总结其诊断及成功救治经验,并结合文献进行复习。结果本例患者体温高达40.5℃,发热伴有四肢强直、持续不自主抖动,肌张力增高,血清肌酸激酶高达104615 U/L,伴有心动过速,血压降低,呼吸频率加快,意识障碍和出汗异常等临床表现,符合恶性综合征诊断标准,并发横纹肌溶解、急性肾损伤,休克等并发症,经早期诊断、积极救治,抢救成功。结论帕金森病患者一旦在用药过程中短时间内出现高热伴强直或是原有帕金森病症状突然加重,应考虑到发生恶性综合征可能,并逐一排查诱因。Objective To increase the understanding of neuroleptic malignant syndrome,rhabdomyolysis and acute renal injury in advanced-aged patients with Parkinson's disease after abdominal surgery.Methods We report a case of malignant syndrome,rhabdomyolysis and acute renal injury in an 85-year-old patient with Parkinson's disease after abdominal surgery in our department.The diagnosis and successful treatment experience were summarized,and a literature review was conducted.Results The body temperature was as high as 40.5℃in this patient,accompanied by stiffness,sustained involuntary shaking,increased muscle tone,serum creatine kinase at 104615 U/L,tachycardia,low blood pressure,accelerated breathing rate,disturbance of consciousness,excessive sweating and other clinical manifestations,which met the diagnostic criteria for neuroleptic malignant syndrome.The patient had complications including concurrent rhabdomyolysis,acute renal injury and shock.The emergency was resolved after an early diagnosis and proactive treatment.Conclusions If patients with Parkinson's disease have a high fever with rigidity or sudden aggravation within a short period of time after medication,the possibility of neuroleptic malignant syndrome should be considered and the causes should be screened.

关 键 词：帕金森病 横纹肌溶解 肾损伤 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R656[医药卫生—临床医学]