60儿童癔症的临床分析

60儿童瘴症的临床分析 河南省精神卫生中心 河南新乡453002 【摘 要】目的为了深入探讨影响儿童瘴症的临床特点。方法对60例儿童瘴 症的临床特点和实验室资料进行分析。并通过MRI, CT,脑电图检查，另外还进 行了心电图，脑脊液，心肌酶等检查。结果60例患者中男26例，女34例；城 市32例，农村28例。发病年龄为7〜15岁,平均9.26plusmn;1.02岁。发 病诱因明确者56例，其中学习负担过重36例，受过批评者是16例，家庭环境 不良4例，临床主要表现为瘫疾22例，产生发作性胸闷、胸痛或憋气和过度通 气的16例，抽搐9例，其他如头疼，晕厥，感觉异常，头晕，幻视等。曾被误 诊15例为癫痫，5例为周期性麻痹，4例为病毒性脑炎，2例为病毒性心肌炎, 其余为发作性睡病，风湿热，过敏性紫瘢，静脉炎，脊髓炎各1例。所有辅助检 查未见阳性指征，排除器质性疾病。结论儿童瘴症很常见，学习负担过重是首 发因素，临床表现复杂，易于误诊，应引起临床医师的重视。 【关键词】瘴症；儿童 Clinical characteristics of hysteria in childhood YUAN Fu-qiang , HanYan, Yu Hong-yan , Xu Ya-nan , Department of Psychiatry, Henan Mental Health Center, Xinxiang 453002 [abstract] Objective To elucidate the Clinical characteristics of hysteria in childhood.s The clinical features of hysteria in 60 children were analyzed. MRh CT and EEG including Video-EEG, 24 hours EEG and conventional EEG were done.Other laboratory examinations such as ECG, CSF, CPK, etc.were also done on some cases. Results Totally 60cases 26 males and 34 females were studied. Among them, 32 cases lived in urban and 28 cases lived in rural areas. The onset of the disease in children was between 7 and 15 years old, average9.26plusmn;1.02 years old.56caseshad known factors of inducement. Among them, 36caseswere due to the heavy load of school work, 16 cases related to the being criticized and 4 cases due to the bad relations betweentheirparents.Th-patients-manifestedasparalysis n22, adnormalrespiration n16 convulsion n9, headache, syncope, sensory, disurbance, dizziness, visual hallacination, etc.The patients were misdiagnosed as epilepsy in 15, periodic paralysis in 5, viral encephalitis in 4, viral myocarditis in 2, narcolepsy in 1, rheumatic fever in 1, anaphylactic purpura in 1, phlebitis in 1 and myelitis in 1 case, respectively. All the examineations were negative, which helped us to exclude other organic diseases. Conclusion The hysteria in childhood were not rare .The heavy load of school work was the most important inducing factor, The clinical manifestations were various, and they were likely to be misdiagnosed.clinicianclinicist shold pay great attention to the hysteria in children. [Key words] Hysteria； child [中图分类号】R749.73【文献标识码】A【文章编号】2096-0867 2016-08-040-02 瘴症在国际疾病分类标准第10版中分别称为转换障碍和 分离障碍，主要指由心理因素引起的，没有可证实的器质性病变基础的躯体和精 神症状⑴。以往成人患病报道较多，儿童瘴症的报道较少，近年来，儿童发病 率逐年升高，旦群体瘴症时有发生，儿童心理健康已成为一个严重的社会问题。 为了深入探讨影响儿童瘴症的的发病诱因、临床特点和治疗效果及预后，现对本 院2013年1月至2016年1月收治的60例儿童瘴症进行回顾性分析，现报告如 To 临床资料和方法 一般资料 60例患儿均符合国际疾病分类标准第10版诊断标准，男26 例,女34例；发病年龄715岁,平均9.26plusmn;1.02岁,城市32例， 农村28例，其中有独生子女为49例；自己家族中母亲有瘴症病史者8例。病前 个性特征60例中有暴躁易怒者9例；固执任性的13例；胆怯懦弱内向的5 例；依赖性强的3例。 方法 1对儿童瘴症的诱因.临床表现.治疗及误诊进行分析。 2对疑似癫痫的患儿进行可视脑电图.24小时脑电图.常规睡眠脑电图 检查。对疑似脊髓病变的患儿进行颈部胸部腰龈部MRI检查，对疑似颅内疾病 的患儿进行头颅CT.MRI及经颅多普勒（TCD）检查,对疑似心肌病变的进行心 肌酶谱检查，另外根据相应症状进行心电图，肌电图，电解质，胸片，脑脊液, 直立调节试验等检查。 结果 一，诱发因素 60例发病前均可追诉到一些明显的具体刺激因素，其中学习负担过重 36例，受过批评者是16例，家庭环境不良4例，与伙伴发生冲突2例，受惊吓 者1例，担心自己要求未能得到满足者1例。 二，临床表现 临床表现复杂多样，出现瘫疾共22例，其中4例表现为四肢瘫，12 例表则现为双下肢瘫5例表则现为双下