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汤海燕.多系统萎缩伴致命性直立性低血压三例临床分析[J].浙江中西医结合杂志,2021,31(4):
多系统萎缩伴致命性直立性低血压三例临床分析
Multiple system atrophy with fatal orthostatic hypotension: clinical analysis on three cases
投稿时间:2020-08-17  修订日期:2021-03-10
DOI:
中文关键词:  多系统萎缩  帕金森病  直立性低血压  误诊
英文关键词:multiple system atrophy  Parkinson's disease  orthostatic hypotension  misdiagnosis
基金项目:湖州市科技局公益性应用研究项目(编号2017GYB20)
作者单位E-mail
汤海燕 湖州市中心医院 wendythy@163.com 
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中文摘要:
      背景:自主神经障碍是多系统萎缩的主要临床特点,包括直立性低血压、泌尿道功能障碍等,其中直立性低血压可严重致猝死。而多系统萎缩中帕金森综合征型早期极易与帕金森病混淆。目的:本文将对多系统萎缩-帕金森综合征型的误诊原因进行分析,并强调直立性低血压在鉴别和诊治过程中的重要性。方法:回顾性分析2018年~2020年于湖州市中心医院神经内科住院及门诊随访的3例多系统萎缩伴直立性低血压患者的临床表现、辅助检查结果和诊断与治疗过程。结果:3例多系统萎缩均表现帕金森综合征型;早期均误诊为帕金森病;均表现严重的致死性直立性低血压,其中1例伴餐后低血压;米多君小剂量疗效均欠佳;3例患者均因直立性低血压跌倒,1例跌倒猝死。结论:直立性低血压有助于临床医生及时识别多系统萎缩-帕金森综合征型,严重的直立性低血压极易导致晕厥和猝死且难治,临床医生需引起警惕并及时防护。
英文摘要:
      Background: Autonomic dysfunction which includes orthostatic hypotension (OT) and urogenital dysfunction is the main clinical feature of multiple system atrophy (MSA). OT can seriously cause sudden death. The early stage of MSA with predominant parkinsonism (MSA-P) is easily confused with Parkinson's disease (PD). Objective: In this paper, the causes of misdiagnosis of MSA-P were analyzed, and the importance of OT in the process of diagnosis and treatment was emphasized. Methods: Clinical manifestations, laboratory examinations, diagnosis and treatment of 3 MSA patients with OT in our hospital from 2018 to 2020 were retrospectively analyzed. Results: 3 patients all showed MSA-P. They were all misdiagnosed by PD in early stages. All patients presented severe fatal OT, 1 of which was accompanied by postprandial hypotension. The efficacy of midodrine at low dose was poor. All 3 patients fell due to OT, and one died of sudden fall. Conclusion: OT is helpful for clinicians to identify the MSA-P. Severe OT can easily lead to syncope and sudden death, and it’s difficult to treat. Clinicians need to be alert to OT and timely take precautions.
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