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1例31岁女性患者因精神分裂症给予利培酮1 mg,2次/d口服,1周后剂量增至2 mg,2次/d。此前患者曾3次间断应用利培酮治疗。本次治疗规律服药49 d,患者精神症状缓解。第50～52天未遵医嘱规律服药。第54天患者出现大汗淋漓,体温达38.5℃。第55天出现意识障碍、心动过速、双上肢肌强直、肌张力增高。心电图示窦性心动过速。实验室检查示:白细胞计数12.3×109/L,胆碱酯酶13 268 U/L,肌酸激酶1447 U/L,利培酮血液浓度70.5μg/L。诊断为抗精神病药恶性综合征(NMS)。立即停用利培酮,进行物理降温、补液、抗心律失常、抗感染、纠正酸碱平衡、护肝等治疗。6 d后患者体温恢复正常,NMS症状消失。换用奥氮平治疗后,未再出现类似症状。
One 31-year-old female patient received oral risperidone 1 mg twice daily for schizophrenia and a dose increase to 2 mg twice daily after one week. Previously, patients had intermittent use of risperidone treatment 3 times. The treatment of medication 49 d, patients with mental symptoms ease. 50 to 52 days did not follow the doctor’s advice medication. Day 54 patients sweating, body temperature reached 38.5 ℃. The first 55 days of disturbance of consciousness, tachycardia, upper limb muscle rigidity, increased muscle tone. Electrocardiogram shows sinus tachycardia. Laboratory tests showed that the leukocyte count was 12.3 × 109 / L, 13 268 U / L of cholinesterase, 1447 U / L of creatine kinase and 70.5 μg / L of risperidone. Diagnosed with anti-psychotic malignant syndrome (NMS). Immediate discontinuation of risperidone, physical cooling, rehydration, anti-arrhythmia, anti-infective, correct acid-base balance, liver protection and other treatment. After 6 days, the patient’s body temperature returned to normal, and the symptoms of NMS disappeared. For the treatment of olanzapine, no similar symptoms no longer appear.