天津医药

• 临床论丛 •    

癫痫患者和非癫痫患者苯妥英钠中毒

胡亚会1,李新2,王纪佐2   

  1. 1. 天津市医科大学第二医院神经内科
    2.
  • 收稿日期:2009-12-04 修回日期:2010-02-25 出版日期:2010-06-15 发布日期:2010-06-15
  • 通讯作者: 胡亚会

Phenytoin toxicity in both epileptic and non-epileptic patients

  • Received:2009-12-04 Revised:2010-02-25 Published:2010-06-15 Online:2010-06-15
  • Contact: hu ya hui

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摘要： 目的 探讨癫痫和非癫痫患者苯妥英钠(PHT）中毒的临床表现、诊断及治疗异同点，并复习PHT中毒的新进展。方法 回顾性分析我院1988-2008年14例癫痫和非癫痫住院患者PHT中毒的临床表现、中毒的原因、用药情况、PHT血药浓度及预后。 结果 两组患者临床皆表现为小脑性共济失调，部分患者有锥体外系和锥体束表现。癫痫患者用药史明确，诊治及时；而3例非癫痫患者皆因不知情用药所致，3例患者因哮喘服用肺宝，医患忽略其PHT成分，拖延诊断达2年左右；其临床表现为发作性共济失调，发作频率与间隔和哮喘发作相一致。PHT中毒预后良好，停药后症状消失。结论 首次报道PHT复方制剂用于治疗哮喘造成中毒3例。因此，凡遇病因不明小脑综合征患者应高度怀疑PHT中毒的可能。PHT不宜作为一线药物用于非癫痫疾患，并对PHT易中毒的药代动力学和中毒的内因和外因进行文献复习。

关键词: 苯妥英钠中毒, 不知情用药, 发作性共济失调

Abstract: 　Objective To study the clinical features ,diagnosis and treatment of phenytoin (PHT) toxicity in both epileptic and non-epileptic patients, a brief review of PHT toxicity also made. Method Retrospective study of 14 cases of acute PHT toxicity admitted to our hospital from 1988 to 2008,analysis were made of their clinical feature, cause of toxicity ,medication of antiepileptic drugs, blood concentration of PHT and prognosis. Results Cerebellar syndrome is the cardinal clinical feature, some of them manifest the extra-pyramidal syndrome in both epileptic and non-epileptic patients. History of taking antiepileptic drugs is straightforward and immediate diagnosis and treatment can be done timely in epileptic patients; in contrast, ambiguity of medications history made the diagnosis and treatment delay and wasting unnecessary examinations in non-epileptic patients. All 3 cases of non-epileptic patients are uninformed ingestion of PHT, in order to control symptoms of asthma they take anti-asthma compound with brand name “fei-bao”，which main component is PHT, their clinical presentation is episode ataxia. Prognosis of acute PHT toxicity is favorable. Conclusion First report of acute PHT toxicity in patients with asthma taking PHT compound. High index of suspicion of PHT toxicity should be raised whenever patients with unexplained cerebellar syndrome are encountered, no matter they are epileptic and non-epileptic. It is inadvisable to use PHT as fist line medication in treating non-epileptic disorders. A brief review discuss the pharmacokinetics of PHT susceptible to toxicity and the mechanism and risk factors of PHT toxicity.

Key words: PHT toxicity, uninformed ingestion of PHT, episode ataxia