慢性精神分裂症合并肠梗阻的临床放射学分析

The clinsial X-ray feature of chronic schizophrenia patients paralytic ileus

目的探讨抗精神病药所致麻痹性肠梗阻的临床放射学特征。方法对56例精神分裂症患者治疗中发生肠麻痹不同时期临床放射学表现进行分析。结果56例临床表现均有渐进式腹胀,肠鸣音减弱或消失。依据卧立位腹部X线平片表现分为四期:胃结肠积气型(早期)19例;结小肠积气型(中期)18例;肠梗阻型(重症期)15例;肠坏死型(晚期)4例。早～中经保守治疗可痊愈;重症～晚期经减药、加用胃肠动力药、行胃肠加压和抗菌等治疗措施,部分可恢复功能;其中3例因低血钾、电解质紊乱和多器官功能障碍而死亡,1例在手术中发现肠坏死面广,粘连而行姑息手术,术后死亡。结论各类抗精神病药均可引起麻痹性肠梗阻,以氯氮平(53.5%)最多见,可能与剂量及个体对药物的敏感性有关,X线检查可及时准确诊断肠梗阻,不同时期采取不同治疗措施,提高精神病的治愈率具有重要意义。

Objective To study the X-ray and clinical feature of paralytic ileus caused by antipsychotic drug. Methods Analyze the ileus type of 56 psychosis who catch ileus during treatment. Results All 56 cases have gradual abdominal distension, bowel sound becoming weak or disappear. X-ray of erecting and standing pos- tion of the belly show 4 types ： 19 cases of aerocolia （ early stages） ; 18 cases of enteric aerocolia （ middle stage） ; 15 cases of enteric aerocolia block （serious stage） ; 4 cases of gangrene of intestine （the later period） . Among which early stages, middle stage and serious stage finally recovered after treatment; 3 patients of the later period catch gangrene of intestine, and finally died because of hypokalemic, electrolyte disturbance and multi organ func tion disturbance, one patient died after operation during which gangrene of intestion was found. Conclusion All kinds of antipsychotic drug can cause paralytic ileus, among which most of them are clozapine （53.5%）. This may related to dosage and sensitivity of different person, X-ray examination can accurately diagnose ileus in time.