一个经过肺部手术的患者的急性高血性脑病变伪装成术后妄想:一个病例报告
Chao-Qin Chen1, Zhen-Ping Hu1, Xu-Jie Ma1
1Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, P. R. China.
手术后的急性高血性脑病变 (AHE) 可以模仿妄想. 甲基甲酸转糖酶缺乏症 (OTCD) 被确定为AHE后麻醉患者的原因,强调需要保持警.
科学领域:
- 神经学 神经学
- 遗传学 是一个遗传学.
- 麻醉学 麻醉学
背景情况:
- 急性高血性脑病变 (AHE) 是一种严重的疾病,经常被误认为是术后狂妄症,特别是在没有肝功能障碍的患者中.
- 这一案例突出了首次报告的AHE因手术压力和全身麻醉而导致的情况.
研究的目的:
- 在没有明显的肝功能障碍的患者中,报告一个被误诊为术后妄想的AHE病例.
- 为了确定该患者AHE的潜在遗传原因.
主要方法:
- 一名41岁的男性患者在全身麻醉下接受了肺切除.
- 手术后的焦虑和精神障碍症状最初被视为妄想,但持续存在.
- 基因测序揭示了甲氨酸转糖酶缺乏症 (OTCD).
主要成果:
- 患者在手术后出现了严重的高氨血 (498μmol/L) 和呼吸道性.
- 尽管进行了包括血液过在内的强化支持性护理,但患者的病情恶化,导致昏迷和死亡.
- 尸体遗传分析证实OTCD是AHE的原因.
结论:
- 在没有肝衰竭的全身麻醉后的AHE呈现出非特异性症状,导致潜在的误诊.
- 临床医生应考虑在患有持续性术后精神障碍的患者中考虑高氨血症.
- 早期识别OTCD对于管理AHE和预防致命结果至关重要.
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