Page 116 - 2020年1月第31卷第2期

·药师与药学服务·

1例抗精神病药恶性综合征患者的药学监护及文献复习 Δ

＊
薛 莹 ，司方莹，刘帅兵（郑州大学第一附属医院药学部，郑州 450000）
#
中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2020）02-0234-05
DOI 10.6039/j.issn.1001-0408.2020.02.20
摘 要 目的：为抗精神病药恶性综合征（NMS）患者的个体化治疗提供参考。方法：对我院于2018年9月19日收治的1例NMS
患者，临床药师全程提供药学监护，并提出用药建议；查阅文献，总结NMS的临床表现、危险因素、发病机制、鉴别诊断及治疗药
物。结果与结论：临床药师结合患者抗精神病药物用药史、NMS特征性临床表现及实验室检查，提出该患者为NMS，医师采纳建
议。在治疗过程中，临床药师针对患者入院前的用药情况和入院后医师的用药方案，建议停用亚冬眠合剂，改用甲磺酸溴隐亭片
并行持续低温仪物理降温，用药疗程至少10 d，医师采纳建议。用药第3天，患者症状开始缓解，第10天症状基本消失，并于第13
天出院。文献复习结果显示，NMS的临床表现主要为高热、肌强直、精神状态改变、自主神经紊乱、磷酸肌酸激酶升高、白细胞增
加等；危险因素包括药物因素、人口统计学因素、遗传因素等；发病机制可能与多巴胺能受体阻断及肌肉骨骼纤维毒性有关；鉴别
诊断主要依据其临床表现，主要包括发病时间、神经肌肉反应性、缓解时间等；常用治疗药物为甲磺酸溴隐亭和丹曲林等。
关键词 抗精神病药恶性综合征；药学监护；临床药师

Pharmaceutical Care of 1 Case of Neuroleptics-induced Malignant Syndrome and Literature Review
XUE Ying，SI Fangying，LIU Shuaibing（Dept. of Pharmacy， the First Affiliated Hospital of Zhengzhou
University，Zhengzhou 450000，China）

ABSTRACT OBJECTIVE：To provide reference for individualized treatment of patients with Neuroleptics-induced malignant
syndrome（NMS）. METHODS：A patient with NMS related to antipsychotics was admitted to our hospital in Sept. 19th 2018.
Clinical pharmacists provided pharmaceutical care throughout the whole process，and put forward suggestions for medication.
Through literature review，clinical pharmacists summarized the clinical manifestations，risk factors，pathogenesis，diagnosis and
therapeutic drugs of NMS. RESULTS & CONCLUSIONS：Based on the history of antipsychotic drug use，the characteristic
clinical manifestations of NMS and laboratory examination，the clinical pharmacist proposed that the patient suffered from
antipsychotic drug-related NMS，and the doctor adopted the suggestions. In the course of treatment，the clinical pharmacist
suggested that the subhibernating mixture should be stopped；Bromocriptine mesylate tablets should be used in combination with
continuous hypothermia instrument for physical cooling，and the treatment course should be at least 10 days according to drug use
before admission and medication plan after admission. The doctor adopted the suggestion. The symptoms began to relieve on the
third day，and the symptoms basically disappeared on the 10th day，then the patient was discharged on the 13th day. The clinical
manifestations of NMS were high fever，myotonia，mental state change，autonomic nervous disorder，creatine phosphokinase and
leukocyte increase etc.；risk factors included drug factors，demographic factors，genetic and etc.；the pathogenesis may be
associated with dopaminergic receptor block and musculoskeletal fiber toxicity；the identification diagnosis was based on clinical
manifestation， including the onset time， neuromuscalar reactivity， remission time， etc.； the commonly used drugs were
bromocriptine mesylate and dantraline.
KEYWORDS Neuroleptics-induced malignant syndrome；Pharmaceutical care；Clinical pharmacist；Liberature review

抗精神病药恶性综合征（Neurdeptics induced malig- 颤、自主神经紊乱、精神状态改变、白细胞增加、磷酸肌
[2]
nant syndrome，NMS）是一种由药物引起的罕见的、不可 酸激酶升高等 。目前，对于如何降低 NMS 发病率、提
预测的不良反应，常与抗精神病药物的使用相关，其患 高治愈率仍是临床面临的一大难题。NMS的临床表现
者死亡率可达 20％～30％ ，临床主要表现为高热、震 与中枢神经系统感染、锂中毒、热休克、中枢抗胆碱能综
[1]
合征、恶性高热及5-羟色胺（5-HT）综合征等多种疾病相
Δ 基金项目：国家自然科学基金资助项目（No.81603204）
[3]
似 ，而且该疾病目前尚未有病理学诊断标准或特异性
＊药师，硕士。研究方向：临床药物治疗与药学服务实践。电话：
诊断标准；此外，该疾病在流行病学、病因学等方面尚存
0371-66862018。E-mail：xue_sysu0527@qq.com
[4]
在许多争议 ，其发病机制尚未明确，可能与多巴胺能受
# 通信作者：主管药师，硕士。研究方向：临床药动学。电话：
0371-66862018。E-mail：Shuaibing.Liu@ucsf.edu 体阻断 [2，5] 及肌肉骨骼纤维毒性 [2，6] 有关。有研究表明，常
·234 · China Pharmacy 2020 Vol. 31 No. 2 中国药房 2020年第31卷第2期