儿童急性药源性肌张力不全101例分析

Analysis of the Acute Drug-Induced Dystonias in 101 Children

目的:分析儿童急性药源性肌张力不全常见的致病药物、临床表现、诊断和处理,预防不合理用药所致的儿童急性药源性肌张力不全的发生。方法:收集2010年7月至2012年12月于我院门诊就诊的和住院的急性药源性肌张力不全患儿,统计并分析原发疾病、致病药物、临床表现和治疗方法等情况。结果:在101例病例中,常见原发病为急性胃肠炎(31.7%)、上呼吸道感染(24.8%);常见致病药物为甲氧氯普胺(31.7%)、氟哌啶醇(26.7%),且使用时多超过常用剂量。临床表现上,肌张力不全发作次数大部分病例少于5次(69.3%),多见语言障碍(84.2%);服用甲氧氯普胺和氟哌啶醇所引起的不良反应临床表现有差异,服用前者后出现颈项强直、扭转活动障碍、面肌抽动、痉挛性斜颈的比例更高(P<0.05)。结论:临床医师应熟悉药物的不良反应,诊断儿童急性药源性肌张力不全时注意与"颅内感染"等疾病鉴别,同时应提醒家长妥善保管家中的备用药品,避免小儿误拿误服。

Objective： To analyze the possible reasons,clinical characteristics,accurate diagnosis and treatment methods of acute drug-induced dystonia in children and to prevent the occurring. Methods： A retrospective analysis was made on the records of children with acute drug-induced dystonia from July 2010 to December 2012,which were from inpatient and outpatient department. Meanwhile the related information was collected such as the primary disease,the causes,clinical features and treatment. Results： In the 101cases,acute gastroenteritis（ 31. 7%） and upper respiratory infection（ 24. 8%） were the two commonest kinds of primary disease. The two commonest kinds of medicines,which caused the children acute drug-induced dystonia were metoclopramide（ 31. 7%） and haloperido（ 26. 7%）. And taking over dose was often in these cases. In clinical situations,the frequency of dystonia attack during the progress was less than five times in most cases（ 69. 3%）,and aphasis（ 84. 2%） was quite often. Compared with haloperidol,nuchal rigidity,torsion dystonia,facial tic and spasmodic torticollis were more often in the cases who took metoclopramide（ P〈0. 05）.Conclusions： Doctors should master the right usage of related drugs,be familiar with theirs side effects,pay more attention to its differential diagnosis with the similar diseases such as intracranial infection,and remind parents to keep medicines at home properly to avoid children＇s mistaking.