背景:我们报告一例氟哌啶醇治疗劳拉西泮引起的躁动性谵妄,这反过来又引发了抗精神病药恶性综合征(NMS)的发作。后一种情况,医疗紧急情况,通过药物治疗和右美托咪定有效治疗,一种多功能和高度选择性的短效α-2肾上腺素能激动剂,具有镇静催眠和抗焦虑作用。
方法:一名有双相情感障碍病史的65岁男性患者在暴饮暴食后出现严重的腹部不适。在他住院期间,他因失眠而静脉注射劳拉西泮。第二天,他变得神志不清,因此在48小时内接受了7剂氟哌啶醇(每次5mg)的治疗。NMS的迹象(热疗,刚性,上肢肌阵鸣,意识受损,呼吸急促,和深色尿液)变得明显,立即停用氟哌啶醇,并开始快速利尿。重症监护室入院时,他很困惑,迷失方向,和明显的激动。右美托咪定输注开始时的目标是达到-1或0的里士满躁动-镇静量表评分。NMS逐渐消退,患者稳定下来,允许在3d后停用右美托咪定。
结论:右美托咪定可能在临床上有助于NMS的管理,很可能是因为它的交感神经活性.
BACKGROUND: We report a case of lorazepam-induced agitated delirium treated with haloperidol, which in turn triggered the onset of neuroleptic malignant syndrome (NMS). The latter condition, a medical emergency, was effectively treated with medical treatment and dexmedetomidine, a versatile and highly selective short-acting alpha-2 adrenergic agonist with sedative-hypnotic and anxiolytic effects.
METHODS: A 65-year-old man with a history of bipolar disorder presented to the emergency department with severe abdominal discomfort after binge eating. During his hospital stay, he received intravenous lorazepam for insomnia. On the next day, he became delirious and was thus treated with seven doses (5 mg each) of haloperidol over a 48 h period. Signs of NMS (hyperthermia, rigidity, myoclonus of upper limbs, impaired consciousness, tachypnea, and dark urine) became apparent and haloperidol was immediately suspended and brisk diuresis was initiated. On intensive care unit admission, he was confused, disoriented, and markedly agitated. Dexmedetomidine infusion was started with the goal of achieving a Richmond Agitation-Sedation Scale score of -1 or 0. NMS was resolved gradually and the patient stabilized, permitting discontinuation of dexmedetomidine after 3 d.
CONCLUSIONS: Dexmedetomidine may be clinically helpful for the management of NMS, most likely because of its sympatholytic activity.