1、多发性硬化病例讨论*1目 录病例介绍病例介绍多发性硬化简介多发性硬化简介药物治疗方案药物治疗方案讨讨 论论2Part 1 Part 1 病例介绍病例介绍3病历资料 姓名:性别：女年龄：49岁身高：166cm体重：66kg体重指数：23.94入院时间：2011.3.1出院时间：2011.3.25住院天数：24天主诉：双下肢麻木、无力1月，渐加重。现病史：患者于入院前1月无明显诱因出现双膝以下麻木、疼痛不适，双下肢力弱，行走时发软，双上肢活动如常，伴有尿急，大便干结，未曾就诊治疗。现双下肢麻木、力弱加重，仅在家人搀扶下可短距离行走，并出现颜面部及双上肢末梢疼痛，门诊以“多发性硬化（复发缓解型）”收
2、住。4病历资料既往史2010年3月在我院诊断为“多发性硬化”；2010年5月再次以“多发性硬化”收住。个人史月经史 15 3-4/30,48岁；生育2女1子，均体健；生活规律，无不良嗜好。药物过敏史否认家族史否认5T：36.2；P：80次次/分；分；BP：90/60mmhg余查体未见明显异常余查体未见明显异常入院查体入院查体 神志清，言语流畅。颈有抵抗，神志清，言语流畅。颈有抵抗，Kernig征、征、Brudzinski征阴性，征阴性，Lhermitte征阳性，双侧鼻唇沟对称，伸舌居中，舌肌纤颤，四肢征阳性，双侧鼻唇沟对称，伸舌居中，舌肌纤颤，四肢肌张力稍高，双上肢肌力肌张力稍高，双上肢肌力5
3、级，双下肢肌力级，双下肢肌力3级，双侧膝腱反射、级，双侧膝腱反射、跟腱反射活跃。右侧面部疼痛过敏，双侧跟腱反射活跃。右侧面部疼痛过敏，双侧T6平面以下痛觉减退，平面以下痛觉减退，双侧双侧Babinski征阳性。征阳性。神经系统查体神经系统查体6住院期间检查住院期间检查实验室检查实验室检查血常规、尿常规、粪常规、血生化、免疫、血凝、脑脊液血常规、尿常规、粪常规、血生化、免疫、血凝、脑脊液常规、生化检查未见明显异常；常规、生化检查未见明显异常；特定蛋白：免疫球蛋白（特定蛋白：免疫球蛋白（TGG）5.98G/L；免疫球蛋白；免疫球蛋白（IGM）0.17G/L；补体；补体C3含量测定（含量测定（C3）
4、0.87G/L。其他检查其他检查颈、胸颈、胸MRI：1.颈、胸髓条索形异常信号影，考虑多发性硬化；颈、胸髓条索形异常信号影，考虑多发性硬化；2.C5/6椎间盘膨出；椎间盘膨出；3.颈胸椎骨质增生，颈胸椎骨质增生，T5、T8-10水平黄韧带增厚。水平黄韧带增厚。视觉诱发电位未见明显异常；听觉诱发电位示：右耳视觉诱发电位未见明显异常；听觉诱发电位示：右耳、波尚未引出。波尚未引出。7多发性硬化（复发缓解型）多发性硬化（复发缓解型）诊断诊断8Part 2 Part 2 多发性硬化多发性硬化9世界多发性硬化日世界多发性硬化日WORLD MS DAYWORLD MS DAY2011.5.252011.5.
5、2510What Is Multiple Sclerosis(MS)?MS is a chronic disease that damages the nerves in thespinal cord and brain,as well as the optic nerves.Sclerosis means scarring,and people with MS develop multiple areas of scar tissue in response to thenerve damage.Depending on where the damage occurs,symptoms ma
6、y includeproblems with muscle control,balance,vision,or speech.1、什么是多发性硬化？多发性硬化症是个慢性疾病，主要损害脊髓、大脑以及视神经。“硬化”的意思是结疤，“多发”是指神经系统的多个部位受到累及，会因神经损伤导致疤痕形成。根据损害发生的位置不同，多发性硬化的症状可能包括肌肉控制或平衡感的下降、视觉障碍或言语问题。11MS Symptoms:Weakness or NumbnessNerve damage can cause:1 Weakness in an arm or leg2 Numbness3 Loss of bala
7、nce4 Muscle spasmsThese symptoms may lead to frequent tripping ordifficulty walking.2、多发性硬化的症状：无力或麻木神经损伤会导致：1 手臂或腿脚的无力2 麻木3 失去平衡4 肌肉痉挛这些症状会导致跌绊或行走困难。12MS Symptoms:Vision ProblemsMore than half of people with MS experience a visionproblem called optic neuritis.This inflammation of the optic nerve may
8、 causeblurred vision,loss of color vision,eye pain,or blindness,usually in oneeye.The problem is usually temporary and tends to improve within a few weeks.In many cases,vision problems are the first sign of MS.3、多发性硬化的症状：视力问题超过半数的多发性硬化患者会有视力问题，称为视神经炎。发炎的视神经可能会导致视力模糊、色觉丧失、眼痛，甚至是失明，这通常只累及一只眼睛。视力问题通常是暂
9、时的，往往在几周内恢复。在许多情况下，视力问题是多发性硬化的首发症状。13MSSymptoms:Speech ProblemsAlthoughless common than vision problems,some people with MS develop slurred speech.This happens when MS damages the nerves that carry speech signals from thebrain.Some people also have trouble swallowing.4、多发性硬化的症状：言语问题虽然言语问题不如视力问题那么普遍，
10、但一些多发性硬化的患者会有言语不清的问题。这是由于疾病损伤了将语言信号从大脑传出的神经。一些人也会有吞咽困难。14Other MS SymptomsMS can take a toll on mental sharpness.Some peoplemay find it takes longer to solve problems.Others may have mild memory loss ortrouble concentrating.Most people with MS also experience some loss of bladdercontrol,because sign
11、als between the brain and bladder are interrupted.Finally,fatigue is a common problem.You may feel tired even after a good nightssleep.5、多发性硬化的其他症状多发性硬化会使人反应迟钝。一些患者发现他们想问题的时间会变长。另一些人会出现轻度的记忆丧失或注意力难以集中。多数多发性硬化的患者遇到的问题还包括膀胱失去控制，这是因为大脑和膀胱之间的信号通路中断。除此之外，疲劳也是一个普遍问题。即使饱睡一夜，患者也会感到疲倦。15Stroke vs.MSConfusion
12、,slurred speech,and muscle weakness can besymptoms of MS,but they can also be signs of a stroke.Anyone who suddenly hastrouble speaking or moving their limbs should be taken to the ER immediately.Treating a stroke within the first few hours provides the best odds of asuccessful recovery.6、中风与多发性硬化的区
13、分混乱，言语不清，肌肉无力，这些都是多发性硬化的症状，但这些在中风时也可能出现。如果突然出现了说话困难或肢体瘫痪，则需立即送去急诊。若在几小时内能够及时治疗，则会使中风恢复的机率大大增加。16How MS AttacksIn people with MS,the bodys own immune systemattacks the tissue surrounding the nerve fibers in the brain,spinal cord,andoptic nerves.This covering is made of a fatty substance called myelin
14、.Itinsulates the nerves and helps them send electrical signals that controlmovement,speech,and other functions.When myelin is destroyed,scar tissueforms,and nerve messages are not transmitted properly.7、多发性硬化怎样破坏人体？在多发性硬化的患者体内，自身的免疫系统攻击大脑、脊髓和视神经的髓鞘，髓鞘由一种脂类构成，它包绕在神经纤维外面，起到绝缘的作用，从而帮助神经发送电信号控制运动、语言等功能。
15、当髓鞘被破坏后，就形成了疤痕瘢痕，导致神经信息不能正常传输。17What Causes MS?The roots of MS remain mysterious,butdoctors see some surprising trends.Its most common in regions far from theequator,including Scandinavia and other parts of Northern Europe.These areasget less sunlight,so some researchers believe that vitamin D(the“s
16、unshinevitamin”)may be involved.Research suggests a possible link between vitamin Ddeficiency and autoimmune disorders,but studies are ongoing.Genetics appearto play a role as well.8、导致多发性硬化的原因多发性硬化的病因依然不为人所知，但医生们总结出一些惊人的规律。疾病在高纬度地区最常见，包括斯堪的纳维亚和北欧其他地区。这些地区接受的光照较少，因此一些研究人员认为，维生素D（“阳光维生素“）可能参与多发性硬化的发病
17、过程。一些研究表明，维生素D缺乏与自身免疫性疾病可能有联系，但这些研究仍在进行中。基因似乎也在其中扮演着一定的角色。18Who Gets MS?MS is at least twice as common in women asit is in men.While it can strike people of any race,whites appear to be mostat risk.The chances of developing the condition are highest between ages 20and 50.9。谁会得多发性硬化？女性得多发性硬化的几率至少是男性的
18、两倍。尽管各种族的人都可以得多发性硬化，但白人似乎是最容易得的。此病的发病年龄集中在20到50岁。19Diagnosing MSTests are often used,along with amedical history and neurological exam,to diagnose MS and rule out other causesof symptoms.More than 90%of people with MS have scar tissue that shows up onan MRI scan.A spinal tap can check for abnormalit
19、ies in the fluid that bathesthe brain and spinal cord.Tests to look at electrical activity of nerves canalso help with diagnosis.Lab tests can help rule out other autoimmuneconditions or infections such as HIV or Lyme disease.10、多发性硬化的诊断在诊断多发性硬化之前，通常需要做一些检查，包括病史采集、神经系统查体以及一些实验室和影像学的检查，用来诊断多发性硬化和排除其他
20、疾病所导致的类似症状。超过90的人能在核磁共振扫描上看到被多发性硬化破坏的疤痕组织。脊椎穿刺检查可以在脑脊液（脑和脊髓浸于其中）发现异常。神经电活动的检查也可以帮助诊断。实验室检查能排除其他的自身免疫性疾病条件或一些感染性疾病，如艾滋病或莱姆病。20How Does MS Progress?MS follows a different pattern in every person,butmany people can manage their disease with treatment Doctors see fourforms:Relapsing-remitting:Symptoms f
21、lare during acuteattacks,then improve nearly completely or remit.This is the mostcommon form of MS.Primary-progressive:MS slowly but steadily worsenswithout improvements or acute flare-ups.Secondary-progressive:Begins as relapsing-remittingtype,then becomes progressive.Progressive-relapsing:The unde
22、rlying disease steadilyworsens.The patient has acute relapses,which may or may not remit.This isthe least common form of MS.11、多发性硬化如何进展？尽管每位患者的疾病进展方式都不尽相同，但基本上可以划归为以下四种类型：复发缓解型复发缓解型：症状急性发作，之后会减轻或完全缓解。这是多发性硬化最常见的类型。原发进展型：疾病进展很慢，但逐步恶化，其中没有好转或恢复。继发进展型：疾病以复发缓解型开始，但之后则逐步恶化。进展复发型：发病后病情逐渐进展，并间有复发，可能或不能缓解。
23、这种类型最为少见。21MS and WeatherResearch suggests that the disease may be more activeduring the summer months.Heat and high humidity may also temporarily worsensymptoms.Very cold temperatures and sudden changes in temperature mayaggravate symptoms as well.12、多发性硬化与天气研究表明，这种疾病可能在夏天更为活跃。温度和湿度较高也许暂时恶化了症状。极冷的天
24、气和温度的骤变可能也会加重病情。22Treating MS:MedicationsWhile there is no cure for MS,there are“disease-modifying drugs”that can reduce the frequency and severity of MSattacks.Use can result in less damage to the brain and spinal cord over time,slowing the progression of disability.When an attack does occur,high-d
25、osecorticosteroids can help cut it short.Many medications are also available tomanage troubling MS symptoms,such as muscle spasms,incontinence,and pain.13、多发性硬化的治疗：药物虽然多发性硬化不能治愈，有一些改变病程的药物能够减少疾病发生的频率和严重程度。药物的使用可减少大脑和脊髓随着时间的推移所遭受的损伤，减缓病情恶化。当疾病处于急性期时，大剂量的糖皮质激素有助于缓解。同时可以使用一些对症的药物，来处理多发性硬化那些令人不安的症状，如肌肉痉
26、挛、大小便失禁和疼痛。23Treating MS:Pain ManagementAbout half of people with MS develop some form ofpain,either as a result of a short circuit in the nervous system or because ofmuscle spasms or strain.Doctors may prescribe antidepressants andanticonvulsant medications to ease nerve pain.Pain medicines and ant
27、i-spasmmedicines may also be used.Muscle pain often responds well to massage andphysical therapy.Be sure to discuss your options with your doctor if you findyourself in pain.14、多发性硬化的治疗：疼痛管理约半数多发性硬化患者会经历不同形式的疼痛，这些疼痛可能是缘于神经系统的短路导致，或是因为肌肉痉挛或劳损。为了缓解神经痛，医生可能会开抗抑郁和抗惊厥药物，也可以用止痛药和抗痉挛药物。按摩和理疗往往能够很好地缓解肌肉疼痛。当
28、你遭受疼痛时，需要与医生讨论你的处境和选择。24 Treating MS:Physical TherapyIf MS affects your balance,coordination,or musclestrength,you can learn to compensate.Physical therapy can help you strengthenmuscles,combat stiffness,and get around more easily.Occupational therapy canhelp you retain coordination in your hands fo
29、r dressing and writing.And ifyoure having trouble speaking or swallowing,a speech therapist can help.15、多发性硬化的治疗：物理治疗如果多发性硬化影响到你的平衡、协调能力或肌肉力量，你可以通过训练加以弥补。物理治疗能够帮助你增加肌肉力量，缓解肌肉僵硬，使行动更方便。职业疗法能使你在穿衣和写字时保持双手的协调性。如果你有说话或吞咽困难，可以向语言治疗师寻求帮助。25Complementary Therapies for MSMany nontraditional therapies for MS
30、 have not beenwell studied.Some people say acupuncture relieves symptoms such as musclespasms and pain,but research to confirm its value isnt conclusive.Othershave reported benefits from injections of bee venom,but a rigorous study,lasting 24 weeks,showed no improvements in disability,fatigue,or the
31、 numberof MS attacks.Its important to inform your doctor about any supplements,specialdiets,or other therapies you want to try.16、多发性硬化的治疗：辅助疗法许多针对多发性硬化的非传统疗法还没得到很好的研究。一些人说针灸可以缓解肌肉的痉挛和疼痛，但是对其效果的研究现在还没有定论。另有一些报道称注射蜂毒对疾病有改善，但一个持续24周的严格研究发现它并没有改善残疾、疲劳或减少多发性硬化的发作的效果。在你尝试任何的辅助疗法、特殊饮食或其他治疗之前，最重要的是要告知你的医生。
32、26 MS and PregnancyDoctors generally agree that its safe for women withMS to get pregnant.Research suggests no increased risk of complications duringpregnancy.In fact,many women have fewer MS symptoms during pregnancy.Highlevels of hormones and proteins may suppress the immune system,reducing theodd
33、s of a new attack.Its best to talk with your doctors before pregnancy,ascertain MS drugs should not be used while pregnant or nursing.In theearly months after delivery,the odds for a relapse can rise.17 多发性硬化与妊娠医生们普遍认为，患多发性硬化的女性怀孕是安患多发性硬化的女性怀孕是安全的全的。研究显示，怀孕期间发生并发症的风险并未增加。事实上，许多女性在怀孕期间的多发性硬化症状会减轻。高水平
34、的激素和蛋白可能会抑制免疫系统，从而减少了新症状产生的可能。在打算怀孕之前，最好同医生进行沟通，因为有些治疗多发性硬化的药物在孕期和哺乳期是不能使用的。在分娩后的头几个月，疾病复发的可能性会上升。27 Staying Mobile With MSThe vast majority of people with MS are able tocontinue walking,though many benefit from some type of assistive device.Orthotic shoe inserts or leg braces can help increase stab
35、ility.When one legis stronger than the other,a cane can help.People with significant problemswith their legs may need to use a walker.And a wheelchair or scooter may bebest for those who are very unsteady or tire easily.18、多发性硬化患者，保持行走能力绝大多数多发性硬化患者都能够保持行走能力，尽管许多人需要借助一些辅助设备。矫形鞋垫或下肢支具可以增加稳定性。当两条腿的力量不均
36、衡时，可以借助拐杖。当下肢的问题严重时，可能需要使用助行器。而轮椅或踏板车可能是那些行走不便患者的最佳选择。28Adapting Your Home for MSMaking a few changes around your home can help youmanage daily activities on your own.Install grab bars inside and outside yourshower or tub.Use a non-slip mat.Add an elevated seat and safety rails to thetoilet.Lower on
37、e of your kitchen counters so you can reach it from a sittingposition.And get rid of any throw rugs,which are a tripping hazard.19、打造适合多发性硬化患者的家在家里做一些变动能使你独立进行日常活动。在浴室或浴缸内外都装上把手，使用防滑垫，安装可升降的座椅和安全轨道以便能够上厕所。降低你的厨房台面，这样你就可以坐着进行烹饪。扔掉地毯，它会成为你的阻绊。29MS and ExerciseExercise can ease stiffness,fatigue,and ot
38、hersymptoms of MS.But overdoing it could make things worse.Its best to startslowly.Try exercising for 10 minutes at a time,then gradually working yourway up to a longer session.Before you begin,check with your doctor about whattype of activity and level of intensity would be most appropriate.A fewpo
39、ssibilities include water aerobics,swimming,tai chi,and yoga.20、多发性硬化与运动运动能够缓解肌肉的紧张、疲劳以及多发性硬化的其他症状。但是，过分的锻炼会使病情加重。最好的办法是循序渐进。刚开始的时候可以一次运动10分钟，然后逐渐增加运动时间。在开始运动之前，需要询问医生你适合什么类型和强度的运动，一些可能的选择包括水中有氧运动、游泳、太极和瑜伽。30Outlook for MSMost people with MS live a normal or near-normallifespan.While the condition m
40、ay make it more difficult to get around orcomplete certain tasks,it doesnt always lead to severe disability.Thanks toeffective medications,rehab therapies,and assistive devices,many people withMS remain active,stay in their jobs,and continue to enjoy their families andfavorite activities.21、多发性硬化的展望
41、大多数多发性硬化的患者能够有正常或接近正常的寿命。虽然疾病可能会使其行走或完成某些任务变得困难，但它很少导致严重的残疾。借助有效的药物治疗、康复治疗和辅助设备，许多患有多发性硬化的人们仍旧活跃在自己的工作中，并继续享受与家人相处及从事喜爱的活动所带来的乐趣。31Part 3 Part 3 治疗进程及监护治疗进程及监护32Day 1结合患者病史、体征、临床表现，可诊断为结合患者病史、体征、临床表现，可诊断为“多多发性硬化（缓解复发型）发性硬化（缓解复发型）”自主神经功能障碍精神或认知功能障碍发作性症状其他症状视力障碍肢体无力感觉异常共济失调33用药目的用药目的药物药物剂量剂量频次频次途径途径时间
42、时间调节免疫0.9%NS薄芝糖肽250ml6ml1/日ivgtt1/36/3改善脑代谢5%GS小牛血清去蛋白250ml20ml1/日ivgtt1/321/3扩张血管，活化神经0.9%NS丁咯地尔250ml0.2g1/日ivgtt1/310/3免疫抑制5%GS甲泼尼龙甲泼尼龙250ml1000mg1/日ivgtt1/36/3保护胃黏膜0.9%NS泮托拉唑100ml40mg1/日Ivgtt1/36/3营养神经，修复髓鞘甲钴胺冻干粉0.5mg1/日Im1/321/3维生素B120mg3/日Po1/321/3预防骨质疏松维D钙咀嚼片600mg1/日po1/321/334Day 6患者精神可，双下肢麻木
43、、力弱及右侧颜面部疼痛较前缓解，四肢肌张患者精神可，双下肢麻木、力弱及右侧颜面部疼痛较前缓解，四肢肌张力稍高，双上肢肌力力稍高，双上肢肌力5 5级，双下肢级，双下肢4 4级；右侧仍痛觉过敏，双侧级；右侧仍痛觉过敏，双侧T6T6平面以平面以下痛觉减退。下痛觉减退。用药目的用药目的药物药物剂量剂量频次频次途径途径时间时间地塞米松入能量组地塞米松入能量组输液，免疫抑制输液，免疫抑制5%GS5%GS胞磷胆碱胞磷胆碱三磷酸胞苷二钠三磷酸胞苷二钠10%Kcl10%Kcl地塞米松地塞米松250ml250ml0.5g0.5g40mg40mg5ml5ml10mg10mg1/1/日日IvgttIvgtt6/36/
44、311/311/3缓解疼痛、冷、麻缓解疼痛、冷、麻木症状木症状5%GS5%GS牛痘疫苗致炎兔皮牛痘疫苗致炎兔皮250ml250ml3.6u3.6u1/1/日日IvgttIvgtt6/36/321/321/3牛痘疫苗致炎兔皮牛痘疫苗致炎兔皮3.6u3.6u1/1/日日ImIm6/36/321/321/3抑酸，保护胃粘膜抑酸，保护胃粘膜西咪替丁西咪替丁0.2g0.2g3/3/日日popo6/36/321/321/335Day 10患者自诉双下肢麻木、力弱较入院时明显好转，今日激素减量。但昨日患者自诉双下肢麻木、力弱较入院时明显好转，今日激素减量。但昨日活动后受凉，现有头痛、咽喉肿痛不适，给予抗生素
45、。活动后受凉，现有头痛、咽喉肿痛不适，给予抗生素。用药目的用药目的药物药物剂量剂量频次频次途径途径时间时间地塞米松入能量地塞米松入能量组输液，免疫抑组输液，免疫抑制制5%GS5%GS胞磷胆碱胞磷胆碱三磷酸胞苷二钠三磷酸胞苷二钠10%Kcl10%Kcl地塞米松地塞米松250ml250ml0.5g0.5g40mg40mg5ml5ml8mg8mg1/1/日日IvgttIvgtt11/311/314/314/3抗感染抗感染0.9%NS0.9%NS头孢呋辛钠头孢呋辛钠250ml250ml2.25g2.25g2/2/日日IvgttIvgtt11/311/314/314/336Day 13患者自诉双下肢麻木
46、、力弱较前明显加重，头痛、咽部不适略有好转，患者自诉双下肢麻木、力弱较前明显加重，头痛、咽部不适略有好转，停用抗生素，今日激素加至原量。停用抗生素，今日激素加至原量。用药目的用药目的药物药物剂量剂量频次频次途径途径时间时间地塞米松入能量地塞米松入能量组输液，免疫抑组输液，免疫抑制制5%GS5%GS胞磷胆碱胞磷胆碱三磷酸胞苷二钠三磷酸胞苷二钠10%Kcl10%Kcl地塞米松地塞米松250ml250ml0.5g0.5g40mg40mg5ml5ml10mg10mg1/1/日日IvgttIvgtt 14/314/321/321/337Day 21患者右下肢麻木、力弱较前明显好转，可独立行走，但右上肢力
47、弱、麻、患者右下肢麻木、力弱较前明显好转，可独立行走，但右上肢力弱、麻、痛未见好转，尤以手指为著。自诉昨晚受凉后再次感冒，测痛未见好转，尤以手指为著。自诉昨晚受凉后再次感冒，测T T：37.6 37.6，病情又略有加重，给予环磷酰胺加强免疫抑制。病情又略有加重，给予环磷酰胺加强免疫抑制。用药目的用药目的药物药物剂量剂量频次频次途径途径时间时间地塞米松入能量地塞米松入能量组输液，免疫抑组输液，免疫抑制制5%GS5%GS胞磷胆碱胞磷胆碱三磷酸胞苷二钠三磷酸胞苷二钠10%Kcl10%Kcl地塞米松地塞米松250ml250ml0.5g0.5g40mg40mg5ml5ml8mg8mg1/1/日日Ivgt
48、tIvgtt21/321/325/325/3免疫抑制免疫抑制0.9%NS0.9%NS环磷酰胺冻干粉环磷酰胺冻干粉250ml250ml0.2g0.2g1/1/日日IvgttIvgtt21/321/325/325/338患者经前期治疗后，右下肢麻木、力患者经前期治疗后，右下肢麻木、力 泼尼松片泼尼松片 80mg 1/80mg 1/日日 popo弱较前明显好转，右上肢麻木状况有弱较前明显好转，右上肢麻木状况有 维维D D钙咀嚼片钙咀嚼片 600mg 1/600mg 1/日日 popo改善，可出院继续口服药物治疗，以改善，可出院继续口服药物治疗，以 西咪替丁西咪替丁 0.2g 3/0.2g 3/日日
49、popo避免在医院因反复受凉、感染而导致避免在医院因反复受凉、感染而导致 卡马西平卡马西平 0.1g 3/0.1g 3/日日 popo病情加重。病情加重。维生素维生素B1 20mg 3/B1 20mg 3/日日 popo 甲钴胺片甲钴胺片 500ug 3/500ug 3/日日 popo疾病转归疾病转归出出 院院出院带药出院带药39患者出院教育姓名：姓名：李彩虹李彩虹 性别：性别：女女 年龄：年龄：4949岁岁 临床诊断：临床诊断：多发性硬化（复发缓解型）多发性硬化（复发缓解型）一、出院带药使用方法：一、出院带药使用方法：药物名称药物名称服用方法服用方法注意事项注意事项维维D钙咀嚼片钙咀嚼片60
50、0mg 1/日日咀嚼后咽下咀嚼后咽下西咪替丁西咪替丁0.2g 3/日日 饭后服用饭后服用卡马西平卡马西平0.1g 3/日日 餐时、用餐后、或两餐之间服用餐时、用餐后、或两餐之间服用维生素维生素B120mg 3/日日 餐后服用餐后服用甲钴胺片甲钴胺片500ug 3/日日餐后服用餐后服用强的松片强的松片80mg 逐渐减量逐渐减量晨起顿服晨起顿服40强的松强的松 80mg qd 80mg qd 服用服用7d 7d 70mg qd70mg qd 服用服用7d 7d 60mg qd60mg qd 服用服用5d 5d 50mg qd 50mg qd 服用服用5d 5d 40mg qd 40mg qd 服用
