抗精神病藥物惡性症候群併發急性腎臟衰竭

Neuroleptic Malignant Syndrome Complicated with Acute Renal Failure

劉金林(Chin-Lin Liu)

指導教授 ： 詹道明

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00131

摘要

抗精神病藥物惡性症候群併發急性腎臟衰竭
劉金林 詹道明
摘要
抗精神病藥物惡性症候群是因使用抗精神病藥物而引起的罕見高致死的併發症，它屬於神經科急診或精神科急診範疇。此惡性症候群的特點為發高燒、肌肉僵硬、自律神經失調、神智改變及血清中肌酸磷酸激酶上升。許多作者提出有關抗精神病藥物惡性症候群的診斷標準，但以現今第四版精神疾病的診斷與統計手冊診斷標準為研究規範為主軸。抗精神病藥物惡性症候群在使用抗精神病藥物的病患中每年發生率為0.01 %至0.02 %，而死亡率為11%至38 %。致死的合併症為急性呼吸衰竭或急性腎臟衰竭。我們報告一位63歲男性患者，已有10年精神分裂病史，發生抗精神病藥物惡性症候群，因為發燒；昏迷送到急診，在加護病房治療期間出現急性腎臟衰竭併發症，經過暫時間斷性血液透析，此病患得以安全出院轉至呼吸照護中心。我們回顧有關抗精神病藥物惡性症候群的文獻，以瞭解診斷標準; 致病機轉; 致病危險因子及治療方法。各科醫師都有機會處方抗精神病藥物，都需瞭解抗精神病藥物惡性症候群並作適當處置，如此可降低抗精神病藥物惡性症候群的死亡率。
關鍵詞: 抗精神病藥物惡性症候群，急性腎臟衰竭

關鍵字

抗精神病藥物惡性症候群 ； 急性腎臟衰竭

並列摘要

Neuroleptic Malignant Syndrome Complicated with Acute Renal Failure

Chin-Lin Liu, Thau-Ming Cham

Abstract

The Neuroleptic Malignant Syndrome (NMS) is a rare but potentially lethal complication of neuroleptic medications. It is a neurologic or psychiatric emergency that may be caused by all antipsychotic drugs. The syndrome is characterized by hyperthermia, muscle rigidity, autonomic dysfunction, alternated mental status and elevated serum creatine phosphokinase (CPK) level. The variable sets of diagnostic criteria for NMS by several authors, the available diagnostic and statistical manual of mental disorders-four edition (DSM-IV) has common used study criteria for NMS. The incidence of NMS varied from 0.01% to 0.02% per year. The mortality is 11%-38%. Death can occur as a result of complication as acute respiratory failure or acute renal failure. We reported an 63-year-old man with a 10-year history of schizophrenic disorder who presented with NMS. He was sent to emergency room under the condition of fever with coma state. He developed acute renal failure in the intensive care unit, he received transient intermittent hemodialysis and survived to respiratory care unit. We reviewed literatures about NMS to understand its history; diagnostic criterias; pathogenesis; risk factors; and treatment. The prescription of neuroleptics may be prescribed by physicians in psychiatric, neurologic, medical and surgical section, all physicians need to recognize and appropriately manage of NMS, then the mortality and morbidity of NMS can be reduced in the future.

Key words: Neuroleptic Malignant Syndrome, Acute Renal Failure

並列關鍵字

Neuroleptic Malignant Syndrome ； Acute Renal Failure

參考文獻

參考文獻

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