甲氧氯普胺致锥体外系反应

Extrapyramidal disorders induced by metoclopramide

1例42岁女性患者,因患急性胃肠炎给予口服甲氧氯普胺10mg,3次/d;阿莫西林1.0g,3次/d。首次服药30min后,患者出现四肢不自主运动,行走困难,头颈向左扭转,下颌偏斜,吐舌,语言含糊。查体:T36.5℃,P96次/min,R24次/min,BP100/70mmHg,神志清楚,反应迟钝,面具脸,头颈向左侧扭转,双侧腱反射亢进,病理反射阴性。考虑为甲氧氯普胺所致锥体外系反应,立即给予阿托品1mg肌内注射,地西泮5mg肌内注射。30min后上述症状逐渐消失。停服甲氧氯普胺,继续服用阿莫西林,上述症状未再出现。

A 42-year-old woman with acute gastroenteritis received oral metoclopramide 10 mg thrice daily and amoxicillin 1.0 g thrice daily. After 30 minutes of the first administration, the woman developed involuntary movement of extremities, difficult walking, leftward head and neck rotation, submaxilla deviation, tongue protrusion, and unclear speech. Physical examination showed a temperature of 36.5℃, a pulse rate of 96 beats/rain, a respiratory rate of 24 breaths/min, and a BP of 100/70 mm Hg. She had consciousness, slowed responses, mask-like face, torsion of head and neck to the left, bilateral tendon hyperreflexia, and negative pathologic reflex. Metoclopramide-induced extrapyramidal disorders were suspected. IM atropine t mg and IM diazepam 5 mg were given immediately. The above-mentioned symptoms disappeared gradually thirty minutes later. Metoclopramide was stopped and amoxicillin was continued. The above-mentioned symptoms did not reappear.