《中国康复理论与实践》

《中国康复理论与实践》 ›› 2011, Vol. 17 ›› Issue (9): 852-855.

• 论文 • 上一篇    下一篇

脑桥中央髓鞘溶解症的临床特征及其康复预后

杜晓霞，宋鲁平，徐建民，何静杰，孙蓉，王强，张通   

  1. 1.首都医科大学康复医学院，北京市 100068；2.中国康复研究中心北京博爱医院神经康复二科，北京市 100068。
  • 收稿日期:2011-08-12 修回日期:2011-09-06 出版日期:2011-09-25 发布日期:2011-09-25
  • 通讯作者: 张通、宋鲁平

Clinical Features and Prognosis of Central Pontine Myelinolysis

DU Xiao-xia, SONG Lu-ping, XU Jian-min, et al.   

  1. Neurorehabilitation Department, Capital Medical University School of Rehabilitation Medicine, Beijing Charity Hospital, China Rehabilitation Research Centre,Beijing 100068, China
  • Received:2011-08-12 Revised:2011-09-06 Published:2011-09-25 Online:2011-09-25

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5

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

Abstract: Objective To analyze the clinical features and prognosis of central pontine myelinolysis. Methods 20 cases with CPM diagnosed 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 (secondary to corticobulbar fiber involvement), flaccid quadriparesis (as corticospinal tract involved) which later became spastic. The myelinolysis distrubuted symmetrically along the myelin disruption in the center basal, as well as independently in other brain areas (extrapontine myelinolysis 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, extrapontine myelinolysis, hyponatremia, hypophysin, Barthel index, Mini Mental State Examination