Stanford A型急性大動脈解離に対する弓部大動脈置換術後の悪性症候群の1例

Experience of Neuroleptic Malignant Syndrome After Operation：Total Arch Replacement for Stanford Type A Acute Aortic Dissection：Report of a Case

はじめに　悪性症候群（neuroleptic malignant syndrome：NMS）は，抗Parkinson病薬の中断や抗うつ薬・制吐薬が原因にもなるが，狭義では抗精神病薬の副作用とされる．発熱・意識障害・錐体外路症状・自律神経症状を主徴とし，治療が行われなければ死亡しうる．発症頻度は抗精神病薬投与患者の0.2％とされ1），心臓大血管術後急性期の発症報告も散見される．術後状態でのNMS発症は全身状態の悪化につながるため，より早期の診断加療が重要となる．われわれはStanford A型急性大動脈解離に対する弓部置換術後に発症したNMSの1例を経験した．

A 50-year-old woman underwent total arch replacement for Stanford type A acute aortic dissection. Postoperatively, she became delirious and experienced difficulty maintaining rest, so haloperidol was used. Due to persistent high fever and markedly elevated serum levels of creatinine kinase, neuroleptic malignant syndrome was suspected. We discontinued haloperidol and started dantrolene. During the same period, we ruled out infections, central nervous system disorders, and organ ischemia due to dissection. Administration of dantrolene achieved a good outcome, with reduction of fever and improvement of creatinine kinase levels. Neuroleptic malignant syndrome after aortic dissection surgery is very rare and includes numerous differential diagnoses. However, prompt action is important because delays in diagnosis and treatment can lead to deterioration in the general condition of the patient.