非成癮者海洛因中毒所造成的神經肌肉病變：病例報告

Neuromyopathy after Heroin Intoxication of Non-addictor: A Case Report

陳扶文(Fu-Wen Chen) ； 朱家宏(Chia-Hung Chu) ； 鍾進燈(Chin-Teng Chung) ； 周崇頌(Chorng-Sonq Chou)

《中華民國復健醫學會雜誌》 30卷2期 (2002/06) Pp. 87-92

摘要

此個案是一位二十五歲的女性，先前並無藥物濫用的情形，未曾吸食或注射海洛因（heroin）。此次因嘗試注射海洛因自殺，昏迷時間約24小時，以naloxone治療。病情穩定後，轉復健科治療。症狀包括左側肢體癱瘓，臉部、耳朵及下頜部位有紅、腫、熱、痛及頸部淋巴結腫大，左臉週邊顏面神經癱瘓（peripheral facial nerve palsy），並於左側髖關節與右側大腿內側有肌肉壞死的現象。入院時患者左側肢體癱瘓，經數日後左側下肢功能逐漸恢復，但右側下肢逐漸呈現癱瘓，經五個月的追蹤左臉週邊顏面神經已完全恢復，左側上肢已部分恢復，但右下肢仍未見改善。文獻提及海洛因中毒的併發症神經肌肉傷害包括單肢癱瘓（monoparesis）到四肢癱瘓（tetraparesis）、類似橫斷性病變（mimicking transverse myelitis） 、橫紋肌溶解（rhabdomyolysis ）以及腰椎薦椎神經叢病變（lumbosacral plexopathy）。雖然海洛因中毒所造成的傷害，至今病因學尚未十分明確，但是機械性、毒性與免疫因子等因素均曾被提及。對於海洛因中毒所引起的併發症之致病因子，被認為是過敏反應、毒性反應或二者皆具，可能性遠高過創傷所引起。本病例由檢查顯示右側腰椎薦椎神經叢及肌肉先前並無明顯被壓迫的現象，因此，由本個案我們認為海洛因所造成的神經傷害是屬於非創傷性所引起。

關鍵字

海洛因中毒 ； 神經叢病變 ； 橫紋肌溶解

並列摘要

This 25 years old female was found comatous for 24 hours after she injected heroin for attempting suicide. She had no history of drug abuse and no history of inhalation or injection of heroin. She received naloxone therapy at first. After her general condition became stable, she was transferred to rehabilitation department. The symptoms included left side hemiplegia; redness, swelling, local heat and tenderness over face, ear and submandibular area; lymph node enlargement over neck; left peripheral facial nerve palsy and necrosis over medial side of right thigh. Later, the function of left lower extremity was better, but right lower extremity became weak. After regular follow-up for 5 months, left peripheral facial nerve palsy got totally recovered, and left upper limb got improved but right lower limb got no obvious improvement. In previous reports, neurological complications of intoxicity of heroin included monoparesis, tetraparesis, mimicking transverse myelitis, rhabdomyolysis, and lumbosacral plexopathy. Although the pathology was not precise on the harm of heroin intoxicity, factors of mechanical, toxicity, and immune were all mentioned. The factors which induced complications of heroin intoxicity were considered as allergy, intoxicity or both of them. The possibility was much higher than truma. By the history of this case, right lumbosacral plexus and muscle had no obvious compression phenomenon. So we consider that the neurological lesion is nontraumatic in this case.

並列關鍵字

heroin intoxication ； plexopathy ； rhabdomyolysis