多次利培酮治疗致抗精神病药恶性综合征

Neuroleptic malignant syndrome after repeated treatment with risperidone

1例31岁女性患者因精神分裂症给予利培酮1 mg,2次/d口服,1周后剂量增至2 mg,2次/d。此前患者曾3次间断应用利培酮治疗。本次治疗规律服药49 d,患者精神症状缓解。第50～52天未遵医嘱规律服药。第54天患者出现大汗淋漓,体温达38.5℃。第55天出现意识障碍、心动过速、双上肢肌强直、肌张力增高。心电图示窦性心动过速。实验室检查示:白细胞计数12.3×109/L,胆碱酯酶13 268 U/L,肌酸激酶1447 U/L,利培酮血液浓度70.5μg/L。诊断为抗精神病药恶性综合征(NMS)。立即停用利培酮,进行物理降温、补液、抗心律失常、抗感染、纠正酸碱平衡、护肝等治疗。6 d后患者体温恢复正常,NMS症状消失。换用奥氮平治疗后,未再出现类似症状。

A 31-year-old woman with schizophrenia received risperidone 1 mg twice daily. One week later, the dose was increased to 2 mg twice daily. The patient had previously received risperidone intermittent treatment for three times. After a 49-day regular treatment, the psychiatric symptoms relieved. On days 50 to 52, she did not adhere to the instructions of the physician for regular use of the drug. On day 54, the patient experienced profuse sweating with a temperature of 38.5 ℃. On day 55, she developed disturbance of consciousness, tachycardia, muscle rigidity of the upper limbs, and hypermyotonia. Her electrocardiograph showed sinus tachycardia. Laboratory tests showed the following findings： white blood cell count 12.3 × 109/L, cholinesterase 13 268 U/L, creatine kinase 1447 U/L. The blood concentrations of risperidone was 70.5 μg/L. Neuroleptic malignant syndrome （NMS） was diagnosed. The medication was stopped immediately. Physical methods for lowering body temperature, fluid supplement, antiarrhythmics, anti- infective therapy, correction of the acid-base imbalance, and liver-protective treatment were given. Six days later, the temperature returned to normal, the NMS symptoms disappeared. After switch to olanzapine therapy, the similar symptoms did not recur.