發生於手術後之抗精神病藥物惡性症候群－－一例報告

Neuroleptic Malignant Syndrome as a Possible Postoperative Complication-A Case Report

抗精神病藥物惡性症候群（neuroleptic malignant syndrome, 以下簡稱NMS），是抗精神病藥物副作用中最少見，卻最嚴重之副作用。1980年代以前死亡率可達20%，爾後由於早期發現、早期治療，死亡率明顯下降，但仍存在有其致命的危險性，特別值得臨床醫師注意。它不僅出現於精神科病患，只要接觸到抗精神病藥物，不論兒童、成人或內外科病人，都有可能發生，故臨床醫師對此症之臨床表徵、危險因子及治療方法必須有所認識。本文提出一例報告：一位51歲女性，患有精神分裂症已有11年之久，本次住院前至少半年的時間，每天服用12mg flupentixol為維持治療。病人於87年2月14日不慎跌倒造成股骨骨折而住院，2月16日開刀行人工關節置換術，於2月17日開始出現意識不清、高燒不退、全身僵硬等症狀，並持續多天。實驗室檢查方面則有CPK上升至1125， WBC輕微上升，EEG有廣泛性皮質功能異常，經排除其他可能疾病後，診斷為NMS，以bromocriptine治療後康復。本文旨在提醒臨床醫師，NMS也有可能是手術後的併發症之一。

The neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication associated with the use of antipsychotic drugs. NMS was usually noted within a few days after commencing treatment with antipsychotics (96% within one month). In some cases, patients who have been on antipsychotics for years with no adverse side effects suddenly develop NMS. In such cases, the most frequent precipitating factors, included physical exhaustion and dehydration which may be operation-related, Already often misdiagnosed, this syndrome is especially likely to be unrecognized in nonpsychiatric settings, acid may occur postoperatively.We reported a case of NMS who have been on antipsychotics for 11 years developed NMS after operation. A 51-year-old woman was diagnosed as schizophrenia for 11 years and treated with flupentixol 12mg per day for at least 6 months prior to this recent admission. She was admitted to the hospital for operation of femoral bone fracture. Postoperatively, she was noted to be obtunded, febrile, and exhibit generalized muscular rigidity. NMS was diagnosed after rule-out other possible etiology. This article is reported in order to help practicing clinicians to recognize, prevent and to discuss the proper managementof this syndrome.