Intrathecal baclofen withdrawal syndrome- a life-threatening complication of baclofen pump: a case report.
Intrathecal baclofen withdrawal syndrome- a life-threatening complication of baclofen pump: a case report.
复制标题
DOI：
10.1186/1472-6904-4-6
复制
发表时间：
2004-08-09
期刊：
影响因子：
--
通讯作者：
Hussain A
中科院分区：
文献类型：
--
作者：
Mohammed I;Hussain A
鞘内巴氯芬泵已被有效地用于严重痉挛患者，特别是对保守药物治疗无反应或口服治疗剂量的巴氯芬产生不可耐受的副作用的患者。鞘内泵输送不正确剂量的巴氯芬可引起嗜睡、恶心、头痛、肌无力、头晕目眩和治疗前痉挛状态的恢复。鞘内注射巴氯芬戒断综合征是一种非常罕见的、可能危及生命的并发症，由鞘内注射巴氯芬突然停止引起。1例24岁男性，既往有脑瘫和痉挛性四肢轻瘫病史，发生高热、弥散性血管内凝血、横纹肌溶解、急性肾衰竭和多系统器官衰竭，导致完全鞘内巴氯芬戒断综合征。鞘内巴氯芬泵分析显示，由于一些编程错误而停止。通过支持性护理、大剂量苯二氮卓类药物和重新设置巴氯芬泵，患者得到有效治疗。鞘内注射巴氯芬戒断综合征的发作大多是由可预防的人为错误或泵故障引起的。对患者及其护理人员进行有关该综合征的教育，并定期检查巴氯芬泵可能会降低鞘内巴氯芬戒断综合征的发生率。口服巴氯芬替代可能不是治疗或预防鞘内巴氯芬戒断综合征的有效方法。管理包括早期识别综合征，适当的重症监护管理，大剂量苯二氮卓类药物和及时分析鞘内泵与巴氯芬重新设置。
Intrathecal baclofen pump has been used effectively with increasing frequency in patients with severe spasticity, particularly for those patients who are unresponsive to conservative pharmacotherapy or develop intolerable side effects at therapeutic doses of oral baclofen. Drowsiness, nausea, headache, muscle weakness, light-headedness and return of pretreatment spasticity can be caused by intrathecal pump delivering an incorrect dose of baclofen. Intrathecal baclofen withdrawal syndrome is a very rare, potentially life-threatening complication of baclofen pump caused by an abrupt cessation of intrathecal baclofen. A 24-year-old man with a past medical history of cerebral palsy and spastic quadriparesis developed hyperthermia, disseminated intravascular coagulation, rhabdomyolysis, acute renal failure and multisystem organ failure leading to a full-blown intrathecal baclofen withdrawal syndrome. Intrathecal baclofen pump analysis revealed that it was stopped due to some programming error. He was treated effectively with supportive care, high-dose benzodiazepines and reinstitution of baclofen pump. The episodes of intrathecal baclofen withdrawal syndrome are mostly caused by preventable human errors or pump malfunction. Educating patients and their caregivers about the syndrome, and regular check-up of baclofen pump may decrease the incidence of intrathecal baclofen withdrawal syndrome. Oral baclofen replacement may not be an effective method to treat or prevent intrathecal baclofen withdrawal syndrome. Management includes an early recognition of syndrome, proper intensive care management, high-dose benzodiazepines and prompt analysis of intrathecal pump with reinstitution of baclofen.