小儿脑中线结构肿瘤术后发生阵发性交感神经过度兴奋3例临床特征分析并文献复习

目的探讨小儿脑中线结构肿瘤术后阵发性交感神经过度兴奋(PSH)的临床特征、治疗方案及预后,提高对小儿脑中线结构肿瘤术后PSH的认识。方法回顾性分析3例患儿脑肿瘤术后发生PSH的临床表现、影像学检查及治疗等资料。结果3例患儿中,男2例,女1例;年龄1~3岁;鞍区占位1例,斜坡占位1例,松果体占位1例。3例患儿为首次颅内病损切除者,表现为术后一过性PSH发作,主要以心动过速、血压升高、呼吸急促为临床表现;影像学检查提示脑损伤部位多为中线附近结构;术后PSH发作时右美托咪定/咪达唑仑、芬太尼、艾司洛尔联合治疗有效,3例患儿均存活。结论小儿脑中线结构肿瘤术后,可出现一过性PSH临床表现,脑损伤急性期PSH发作时右美托咪定/咪达唑仑、芬太尼、艾司洛尔联合治疗有效,多预后良好。

Clinical characteristics of paroxysmal sympathetic hyperactivity after operation with pediatric cerebral midline structure tumors(3 cases report and literature review)

Objective To investigate the clinical features,treatment and prognosis of paroxysmal sympathetic hyperactivity(PSH)after operation with pediatric cerebral midline structure tumors,and to improve the understanding of PSH.Methods The clinical data including the clinical manifestations,imaging examination and treatment of 3 patients diagnosed as PSH after cerebral tumor resection were analyzed retrospectively.Results Of the 3 patients,2 were male and 1 female,aged 1-3 years,including1 saddle area,1 slope area and 1 pineal gland area.3 cases were the first removal of intracranial lesions,which showed a transient PSH attack after operation,mainly including tachycardia,elevated blood pressure and shortness of breath.Imaging examination showed that most of the brain injury sites were near the midline.Dexmedetomidine/midazolam,fentanyl and esmolol were effective in the onset of postoperative PSH,and all 3 children survived.Conclusions Transient clinical manifestations of PSH may occur after operation with pediatric cerebral midline structure tumors.Combined treatment with dexmedetomidine/midazolam,fentanyl and esmolol was effective in the onset of PSH in the acute stage with good prognosis.