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目的 报道 5例脑桥中央髓鞘溶解 (CPM)患者的临床资料及其中 1例的尸解病理检查资料 ,探讨CPM的发病机制及早期预防和诊治原则。方法 对 5例确诊CPM患者的临床表现、影像学资料及其中 1例尸检病理资料进行全面分析。结果 临床观察发现 :① 5例CPM患者均存在严重躯体疾病 ,特别是严重的电解质紊乱 (低钠血症 ) ;② 4例以精神行为异常为最早发现的症状 ;③ 4例出现假性球麻痹 ;④全部出现不同形式的肢体瘫痪 ;⑤头颅MRI 3例阳性 ;⑥ 1例病理检查显示为桥脑髓质非特异性对称性脱髓鞘改变 ;⑦ 5例患者中 4例存活 ,其中 2例恢复独立生活能力。结论 ①CPM的发病与严重电解质紊乱 (特别是低钠血症 )及过快补钠有关 ;②CPM是一种自限性疾病 ,无论病情多严重 ,均不应放弃救治机会。
Objective To report the clinical data of 5 patients with central pontine myelinolysis (CPM) and one case of autopsy pathology, and to explore the pathogenesis of CPM and the principles of early prevention and diagnosis. Methods A total of 5 cases of confirmed CPM patients with clinical manifestations, imaging data and a case of autopsy pathology data for a comprehensive analysis. Results The clinical observation showed that: (1) all the 5 CPM patients had severe somatic diseases, especially severe electrolyte disturbance (hyponatremia); 4 were the earliest symptoms of mental disorders; (4) 4 cases had pseudobulbar palsy ; ④ all the different forms of limb paralysis; ⑤ cranial MRI in 3 cases; ⑥ 1 case of pathological examination showed non-specific pontine medulla asymmetric demyelination; ⑦ 4 cases of 5 patients survived, of which 2 patients regained independence Survival skills. Conclusions ① The incidence of CPM is associated with severe electrolyte imbalance (especially hyponatremia) and sodium hyperactivity; (2) CPM is a self-limited disease and should not be given any chance of treatment, no matter how serious the disease is.