脑桥中央髓鞘溶解症的临床特征及其康复预后①.pdfVIP

中国康复理论与实践2011年9月第17卷第9期 ChinJRehabilTheoryPract,Sep.2011,Vol.17,No.9 - 852 - ·临床研究· 脑桥中央髓鞘溶解症的临床特征及其康复预后① 杜晓霞，宋鲁平，徐建民，何静杰，孙蓉，王强，张通 [摘要] 目的 研究脑桥中央髓鞘溶解症(CPM) 的临床特征、康复和预后。方法 回顾性分析并随访本院近10年确诊的CPM 综合征患者20 例，并与国外大型研究进行比较。结果 与国外相比，国内应用垂体后叶素引起的渗透性髓鞘溶解综合征相对多 见，并发脑桥外髓鞘溶解症(EPM)多见；主要在低钠血症快速纠正后2~ 10 d 内出现迅速进展的皮质延髓束或皮质脊髓束症候群。 康复治疗可以改善症状，但严重构音障碍者语言功能改善差。结论 CPM 患者康复治疗有助于功能改善。应用垂体后叶素时注意 监测电解质变化，低钠血症患者需严密监测、严格遵循补钠原则。 [关键词] 脑桥中央髓鞘溶解症；脑桥外髓鞘溶解症；低钠血症；垂体后叶素；Barthel 指数；简易智能评定量表 Clinical Features and Prognosis of Central Pontine Myelinolysis DU Xiao-xia, SONG Lu-ping, XU Jian-min, et al. Neurorehabilitation Department, Capital Medical University School of Rehabilitation Medicine, Beijing Charity Hospital, China Rehabilitation Research Cen - tre, Beijing 100068, China Abstract: Objective To analyze the clinical features and prognosis of central pontine myelinolysis. Methods 20 cases with CPM diag- nosed in last 10 years were reviewed and compared with those patients of foreign studies. Results 10 patients with hemoptysis were treated with hypophysin, which resulted in severe hyponatremia and osmotic myelinolysis. The main syndrom were dysarthria and dysphagia (sec- ondary to corticobulbar fiber involvement), flaccid quadriparesis (as corticospinal tract involved) which later became spastic. The myelinoly- sis distrubuted symmetrically along the myelin disruption in the center basal, as well as independently in other brain areas (extrapontine my- elinolysis or EPM), including the cerebellar and neocortical white/gray junctional areas, thalamus and striatum. Conclusion Supplement of sodium should be slower and more persistent for hyponatremia, the selection of drugs should be based on the patients specific conditions. Key words: central pontine myelinolysis; extra