氯氮平所致锥体外系反应太原精神病院（０３００４５）王桂香，任玉伟氯氮平作为一种新型抗精神病药物已广泛应用于临床，对于急、慢性精神分裂症，幻觉、妄想、兴奋躁动、拒食等均有显著疗效。但我们在应用过程中发现１４例出现锥体外系反应，特报告如下。临床资料１００例单用氯氮平治疗精神分裂症患者，其中男６２例，女３８例；年龄１５～６１岁，平均２８岁；病程０．５～２２年，平均４．９年；首次住院３５例，二次以上者６５例。偏执型３５例，紧张型１３例，单纯型１６例，未定型１２例，衰退型２４例。治疗中每月进行１～２次血常规、肝功能、心电图检查，单一治疗剂量为７５～４５０μｇ／日。１４例出现锥体外系反应，出现时间为用药后３周内，与药物的剂量大小无关。主要表现为程度不同的四肢肌张力增高、行动不便，说话口齿不清，流涎，严重时有吞咽困难，小便失禁，同时停服药物给抗胆硷药物如安坦、东莨菪硷等对症处理，反应缓解以至消失。我们曾多次给病人再次服药，利用单盲法进行暗示（将５０ｍｇ氯氮平研成细沫装入胶囊中）并提示此药是×××进口药，以消除其心理作用，服用后同样出现上述反应。讨论１．氯氮平属抗精神病药，其化学结构是侧链上有一哌嗪基，他的基本结构类似三环 Clozapine induced extrapyramidal reactions Taiyuan mental hospital (030045) Wang Guixiang, Ren Yuwei Clozapine as a new antipsychotic drugs has been widely used in clinical, acute and chronic schizophrenia, hallucinations, delusions, agitation, antifeedant Dengjun have significant effect. However, we found in the application of 14 cases of extrapyramidal reactions, special report is as follows. Clinical data 100 cases of clozapine alone treatment of schizophrenia patients, including 62 males and 38 females; aged 15 to 61 years, mean 28 years; duration of 0.5 to 22 years, an average of 4.9 years; first hospitalization 35 cases, more than 65 cases of secondary. There were 35 cases of paranoid type, 13 cases of tension type, 16 cases of simple type, 12 cases of unconfined type and 24 cases of recessive type. Treatment of blood 1 month, 2 times a month, liver function, ECG, a single treatment dose of 75 ~ 450μg / day. 14 cases appeared extrapyramidal reactions, the emergence of time within 3 weeks after treatment, and drug dose size has nothing to do. Mainly manifested as varying degrees of limb muscle tension, mobility, speechless, saliva, severe dysphagia, urinary incontinence, while stopping taking drugs to anticholinergic drugs such as Antan, scopolamine and other symptomatic treatment, Response to disappear. We have repeatedly to the patient medication again, the use of single-blind method implied (50mg clozapine into fine foam into the capsule) and prompts the drug is × × × imported drugs to eliminate their psychological effects, after taking the same The above reaction occurred. Discussion 1. Clozapine is an antipsychotic drug whose chemical structure is a piperazinyl group on the side chain and whose basic structure resembles tricyclic