脂肪乳治疗急性安定中毒的剂量优化观察  

Dose optimization of lipid infusionin treatment of patients with acute dexmedetomidinepoisoning

作　　者：王晋鹏[1] 黄新文[1] 郑保健[1] 翁银燕[1] 

机构地区：[1]浙江省立同德医院急诊科,杭州310012

出　　处：《中华医学杂志》2016年第15期1201-1204,共4页National Medical Journal of China

摘　　要：目的 优化脂肪乳治疗急性安定中毒的有效安全剂量以指导临床合理用药.方法 2012年1月至2014年10月期间浙江省立同德医院急诊科收治的急性安定中毒患者80例,根据其临床表现分为轻度中毒组（28例）、中度中毒组（32例）和重度中毒组（20例）.每组患者随机给予10％脂肪乳治疗或20％脂肪乳治疗.比较各组患者在不同剂量脂肪乳治疗前0.5h与治疗后0.5、1、2、5、10、20 h安定的血药浓度、苏醒和住院时间.同时监测治疗前0.5h与治疗后2、5、20 h的Ramsay镇静深度评分.记录患者治疗中的不良反应和并发症,出院后1～3d随访,了解患者恢复情况.结果 3组患者中,接受20％脂肪乳治疗患者的苏醒时间均明显早于10％脂肪乳治疗的患者,接受20％脂肪乳治疗患者的住院时间均明显短于接受10％脂肪乳治疗的患者[（4.6±1.6）h比（6.7±2.0）h,（2.6±0.4）d比（4.0±0.6）d,P＜0.05].而且,3组患者在治疗后2h和5h的Ramsay镇静深度评分,差异均有统计学意义[（3.4±0.3）比（4.7±0.4）,（2.6±0.3）h比（3.5±0.3）h,P＜0.05].接受20％脂肪乳治疗患者的Ramsay镇静深度评分均明显低于接受10％脂肪乳治疗的患者,所有患者于脂肪乳治疗后1h开始,血液安定浓度逐渐降低,其实测安定血药浓度均低于理论代谢浓度.3组患者中,接受20％脂肪乳治疗的患者安定血药浓度均明显低于接受10％脂肪乳治疗的患者.3组患者治疗后均痊愈出院,无患者出现并发症,出院后1～3d随访,无患者出现反跳现象.结论 不同浓度的脂肪乳均可在短时间内显著降低不同程度安定中毒者患者体内的安定血药浓度,达到急性中毒解救临床疗效.但20％浓度的脂肪乳治疗效果明显优于10％脂肪乳.Objective To optimize the dose of lipid infusion in treatment of patients with acute dexmedetomidinepoisoning,in order to further guide the rational use of medication in clinical practice.Methods A total of 80 patients with acute dexmedetomidinepoisoning were admitted in this study from January 2012 to October 2014 at our hospital and divided into three groups based on the intensity of poisoning,including：slight poisoning （28 cases）,moderate poisoning （32 cases） and severe poisoning （20 cases）.Patients in each group were given 10％ lipid infusion or 20％ lipid infusion for treatment.Stable blood dexmedetomidineconcentrations of patients in pre-treatment and at different time points after treatment （pre-treatment and 0.5,1,2,5,10,20 h after treatment） and the length of hospital stay,awake time in each group were investigated and compared.Ramsay sedation scores were recorded and compared in different time points （0.5 h before treatment and 2,5,20 h after treatment） in each group for different treatments.Side effects and complications were recorded,and follow-up was conducted during 1-3 d post discharge to record the recovery condition in patients.Results In each group,patients receiving 20％ lipid infusion waked earlier than those receiving 10％ lipid infusion.And the hospitalization duration for patients receiving 20％ lipid infusion was significantly shorter than those receiving 10％ lipid infusion [（4.6 ± 1.6） h vs （6.7 ± 2.0） h,（2.6 ± 0.4） d vs （4.0 ± 0.6） d,P ＜ 0.05].The Ramsay sedation scores were significantly lower for patients receiving 20％ lipid infusion than those receiving 10％ lipid infusionat 2 h and 5 h after treatment in each group [（3.4±0.3） vs （4.7±0.4）,（2.6±0.3） h vs （3.5±0.3） h,P＜ 0.05].The stable plasma concentrations of dexmedetomidine were gradually reduced after the treatment,and which were lower when compared with the theoretical metabolic concentration.What＇s more,the plasma concentrationsat 1 h,2 h and 5 h after

关 键 词：脂肪乳剂 静脉注射用 安定 中毒 血药浓度 镇静深度评分 

分 类 号：R595.4[医药卫生—内科学]