Yanagawa Youichi, Miyazaki Masaki
Department of Traumatology & Critical Care Medicine, National Defense Medical College, Tokorozawa 359-8513.
Masui. 2010 Feb;59(2):235-7.
An 18-year-old woman was treated with neuroleptic analgesia using fentanyl, morphine, droperidol and haloperidol for general anesthesia and pain control for her knee operation. Postoperatively, she showed emotional unstableness, following dyspnea, tachycardia, fever, hyperhydrosis, muscle rigidity and myoclonus like involuntary movement. She received infusion of 140 mg dantrolene in total under suspicion of having neuroleptic malignant syndrome, but her symptoms improved slightly. After being transferred to our hospital, she exhibited immobility, mutism, rigidity, and catalepsy, and she was suspected of having lethal catatonia. Infusion of diazepam 10 mg resulted in dramatical improvement of her symptoms. Differential diagnosis between neuroleptic malignant syndrome and catatonia is difficult; however, a first line therapy is differential diagnosis. Thus, physician should consider catatonia when treating neuroleptic malignant like syndrome.
一名18岁女性在膝关节手术中使用芬太尼、吗啡、氟哌利多和氟哌啶醇进行神经安定镇痛以实施全身麻醉和控制疼痛。术后，她出现情绪不稳定，随后出现呼吸困难、心动过速、发热、多汗、肌肉僵硬以及类似肌阵挛的不自主运动。怀疑她患有神经安定恶性综合征，总共为她输注了140毫克丹曲林，但她的症状稍有改善。转入我院后，她表现出不动、缄默、僵硬和蜡样屈曲，怀疑患有致死性紧张症。输注10毫克地西泮后她的症状显著改善。神经安定恶性综合征和紧张症之间的鉴别诊断很困难；然而，一线治疗是进行鉴别诊断。因此，医生在治疗类似神经安定恶性综合征时应考虑到紧张症。
