长期大剂量服用复方妥英麻黄茶碱片致共济失调和肌张力障碍

Ataxia and myodystony due to long-term and high-dose use of compound phenytoin sodium, ephedrin hydrochloride and theophylline tablets

1例79岁女性患者,因慢性阻塞性肺疾病口服复方妥英麻黄茶碱片2片,2次/d.用药2个月间断出现头面部不自主运动;用药9个月间断出现头晕,伴双下肢无力、步态不稳.用药1年后因疗效不佳,自行改为每次5片,2次/d.大剂量用药2年后头面部不自主运动和头晕加重,并出现身体后仰、无法站立行走.考虑为长期大剂量服用复方妥英麻黄茶碱片致共济失调、肌张力障碍.停用该药,给予0.9％氯化钠注射液500 ml静脉滴注、1次/d,腺苷钴胺1.5 mg肌内注射、1次/d.3 d后,患者头面部不自主运动消失,头晕明显减轻;5 d后,在他人搀扶下可以行走;8 d后,可独立行走.

A 79-year-old female patient with chronic asthmatoid pulmonary disease received compound phenytoin sodium,ephedrin hydrochloride and theophylline tablets 2 tablets twice daily by mouth. The patient developed discontinuous cephalic and facial involuntary movements after 2 months of medication and discontinuous dizziness with weakness of the lower limbs and gait instability after 9 months of medication. After 1 year of medication,the patient changed 2 to 5 tablets twice daily by herself due to the poor curative effect. Two years after high-dose of treatment,the patient developed aggravated involuntary movements and dizziness,body backward and was unable to stand and walk. Ataxia and myodystony due to long-term and high-dose use of compound phenytoin sodium,ephedrin hydrochloride and theophylline tablets was considered. The drug was stopped,an IV infusion of 0. 9% sodium chloride injection 500 ml once daily and an intramuscular injection of adenosine cobalamin 1. 5 mg once daily were given. Three days later,the patient′s cephalic and facial involuntary movements disappeared and dizziness markedly alleviated. Five days later,the patient could walk with other person′s help. Eight days later,the patient could walk alone.