儿童发作性睡病33例临床分析

目的:探讨儿童发作性睡病的发病年龄、临床表现、诊断方法及治疗药物。方法:回顾分析2009年12月至2011年12月郑州大学第一附属医院小儿内科诊断的发作性睡病33例,均给予多导睡眠监测(poly-somnography,PSG)和多次小睡潜伏期实验(multiple sleep latency test,MSLT),应用盐酸哌甲酯、文拉法新等药物进行治疗。结果:20例患儿在5～8岁期间发病,呈现出一个发病高峰年龄;33例患儿均出现白天睡眠过多,30例患儿伴有猝倒,29例患儿伴有体重增加,13例患儿伴有睡眠幻觉,6例患儿伴有睡眠瘫痪;33例患儿平均睡眠潜伏期均≤5 min,均出现2次或2次以上睡眠开始于REM睡眠(SOREM现象);应用盐酸哌甲酯和文拉法新治疗症状控制良好,一旦停药症状会再次出现。结论:儿童发作性睡病存在高发年龄段,PSG和MSLT检查在明确诊断和鉴别诊断中具有重要价值,治疗上需长期应用药物控制症状发作。

Analysis of 33 children with narcolepsy

Objective: To explore the age of onset,clinical manifestations,diagnosic methods and treatment in children with narcolepsy. Methods: The clinical data of 33 narcolepsy children,which were diagnosed by the department of pediatrics of the First Affiliated Hospital of Zhengzhou University from March of 2009 to March of 2011 were analyzed retrospectively.All the patients were given polysomnography(PSG) and multiple sleep latency test(MSLT),and were treated with methylphenidate and venlafaxine. Results: 20 cases of children were in 5～8 years old,showing a peak age of onset.Excessive daytime sleepiness appeared in 33 cases,cataplexy in 30 cases,weight gain in 29 cases,hypnagogic hallucinations in 13 cases,and sleep paralysis in 6 cases.All the 33 cases demonstrated a short mean sleep latency(≤5 min)and two or more sleep onset REM periods(SOREM).Application of methylphenidate and venlafaxine could get a good effect,but the symptoms recurrenced once stopping drug therapy. Conclusion: Children with narcolepsy have a high incidence of age.PSG and MSLT are important in the diagnosis and differential diagnosis.Treatment requires long-term drug therapy to control symptoms.