度洛西汀致神经阻滞剂恶性综合征  

Neurolepic malignant syndrome induced by duloxetine

作　　者：周长凯[1] 李文静[1] 郝晓佳 刘东华[1] 纪洪艳 邢晓敏[1] 李静[1] Zhou Changkai;Li Wenjing;Hao Xiaojia;Liu Donghua;Ji Hongyan;Xing Xiaomin;Li Jing(Department of Pharmacy,the Affiliated Hospital of Qingdao University,Shandong Province,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院药学部,青岛266000

出　　处：《药物不良反应杂志》2023年第3期183-185,共3页Adverse Drug Reactions Journal

摘　　要：1例69岁男性抑郁症患者长期服用安非他酮联合米氮平治疗, 因症状控制不佳, 将治疗方案调整为度洛西汀(60 mg晨服)和米氮平(15 mg口服、1次/每晚)。治疗13 d后患者出现高热(41.0 ℃)伴意识障碍, 随后出现肌强直, 呼吸困难, 心率180次/min;血氧饱和度0.84;实验室检查示血清肌酐(Scr)609 μmol/L, 肌酸激酶(CK)7 102 U/L, 肌红蛋白(MYO)>3 000 μg/L, 天冬氨酸转氨酶(AST)88 U/L, 总胆红素(TBil)33.7 μmol/L;心电监护示快速型心房颤动。排除感染等情况后考虑患者为度洛西汀引起的神经阻滞剂恶性综合征。立即停用度洛西汀和米氮平, 给予气管插管、血液净化、改善水电解质平衡、保肝等支持治疗。停药第6天, 患者体温38.2 ℃, 血氧饱和度0.96, 肌张力改善, 肌肉震颤消失。停药第16天, 患者病情明显好转, 体温正常, 神志清楚, 呼之可应, 无肢体抽搐和肌肉震颤, 肌张力正常, Scr 116 μmol/L, CK 250 U/L, MYO 148 μg/L, AST 38 U/L, TBil 21.4 μmol/L。A 69-year-old male patient with depression was treated with amfebutamone and mirtazapine for a long time.Because of poor control of symptoms,the treatment plan was adjusted to oral duloxetine(60 mg in the morning)and mirtazapine(15 mg at night).After 13 days of treatments,the patient developed high fever(41.0℃)with disturbance of consciousness,followed by muscle rigidity and dyspnea.His heart rate was 180 beats/min and blood oxygen saturation was 0.84.Laboratory tests showed serum creatinine(Scr)609μmol/L,creatine kinase(CK)7102 U/L,myoglobin(MYO)>3000μg/L,aspartate aminotransferase(AST)88 U/L,and total bilirubin(TBil)33.7μmol/L.ECG monitoring showed rapid atrial fibrillation.The patient was diagnosed with malignant syndrome caused by duloxetine after excluding infection and other conditions.Duloxetine and mirtazapine were stopped immediately,and symptomatic and supportive treatments including endotracheal intubation,hemofiltration,improvement of water-electrolyte balance,and hepatoprotection were given.On the 6th day of drug withdrawal,the patient′s temperature was 38.2℃,the blood oxygen saturation was 0.96,muscle tone was improved,and muscle tremor disappeared.On the 16th day of drug withdrawal,the patient′s condition was obviously improved,the consciousness was clear,the temperature was normal,the call could be answered,and no limb convulsion and muscle tremor occurred.Laboratory tests showed Scr 116μmol/L,CK 250 U/L,MYO 148μg/L,AST 38 U/L,and TBil 21.4μmol/L.

关 键 词：度洛西汀 神经阻滞剂恶性综合征 抑郁症 

分 类 号：R969[医药卫生—药理学]