抗精神病药恶性症状群的临床分析

Clinical Characteristics of 24 Psychotic Patients with Neuroleptic Malignant Syndrome

目的:了解抗精神病药致恶性症状群(NMS)的发生原因、临床特征、治疗及预后,并提出预防措施。方法:从住院病历中抽取使用抗精神病药物治疗的25678例患者,按Levenson等提出的NMS诊断标准诊断为NMS的患者24例并进行分析。结果:25678例患者中发生NMS率为0.93‰,发生年龄平均(32.6±7.8)岁,男女比例为1.7∶1,单一用药7例(29.2%),其中使用氟哌啶醇4例(57.1%);合并用药17例(70.8%),其中使用长效制药11例(78.6%)。诱发NMS因素为脱水14例(58.3%)。共死亡1例(4.2%)。结论:NMS大多发生于青壮年,男比女约多1倍,有逐年下降趋势。单一使用氟哌啶醇或合并用药(尤其合并长效制剂)较易发生NMS。脱水是个体因素中诱发NMS的最危险因素。合理使用抗精神病药物,防治个体诱发因素可减少NMS的发生。早期发现和治疗有利于NMS的预后。

Objective： To investigate the etiology, clinical characteristics, treatment and prognosis and present the prophylactic measures. Methods： 25 678 inpatients who had been administered with antipsyehotie drugs during their hospitalization from January 1996 to December 2006 was sorted for investigation. There were 24 eases of NMS according to Levenson＇s diagnostic criteria. Results： The onset age of NMS ranged from 20 to 59 （32. 6±7.8）. The ratio of male to female was 1.7：1. The total incidence was 0. 93%. Seven eases of NMS were subjected to mono-therapy （29. 2%）, among them 4 received haloperidol （57. 1% ）. In 17 cases receiving combined therapy, 11 eases （78.6% ） were administrated with long-acting depots. One predisposing cause was dehydration （14/24, 58. 3%） and there was one death （4. 2%）. Conclusion： Most of NMS occurred in young patients. The incidence in males approximately doubled that of females. The incidence of NMS in this study was a little bit lower than that of certain Asian area reported before and it declined gradually during this decade. Mono-therapy with haloperidol and combined therapy, especially with long-acting depots may contribute to NMS. NMS rarely occurs while atypical antipsyehotie drugs were used. Dehydration was the most risk factor to cause NMS among individuals. The potential prophylactic measures include sound administration of antipsyehotie drugs and prevention of individual inducements. Early diagnosis and early treatment could improve the prognosis of NMS.