超剂量服用丙戊酸钠及齐拉西酮致急性中毒  

Acute toxicity due to overdosage of sodium valproate and ziprasidone

作　　者：程刚英[1] 邓艾平[1] 王奕[1] 刘珏[1] 周庆[1] 

机构地区：[1]华中科技大学同济医学院附属武汉中心医院药学部,430014

出　　处：《药物不良反应杂志》2017年第1期74-75,共2页Adverse Drug Reactions Journal

摘　　要：1例45岁、有10余年吸毒史的男性患者单次自行服用丙戊酸钠缓释片96片（48g）及齐拉西酮胶囊20余粒（〉400mg）后出现昏迷，呼之不应，家属发现后立即将其送医。患者入院时无自主呼吸，四肢及颈部肌张力低下（2级），立即给予气管插管接呼吸机辅助呼吸、洗胃、灌肠、补液、利尿、促醒等对症支持治疗。2h后患者呼之能应，动脉血氧分压（PaO2）292mmHg（1mmHg=0．133kPa），乳酸5．70mmol/L，D-二聚体7．8mg／L，血浆纤维蛋白降解产物（FDP）45mg／L；24h后患者PaO298mmHg，乳酸1．7mmol／L，D-二聚体2．2mg／L，FDP19mg／L，拔除气管插管；48h后患者神志恢复，可配合指令动作，但仍嗜睡；7d后患者能正确回答问题，肌张力恢复正常，偶有轻度嗜睡。A 45-year-old man with about 10 years of drug abuse history took 96 tablets of sodium valproate sustained-release （ 48 g） and about 20 capsules of ziprasidone hydrochloride （ 〉 400 mg） by himself one time. He appeared comatous and had no response to being called, then he was sent to the hospital by his family members. He presented no autonomous respiration, hypotonia of the four limbs and neck （2 level） on admission. He received symptomatic supportive treatments including tracheal intubation and ventilator assisted breathing, gastric lavage, coloclyster, fluid infusion, diuresis, and central nervous system stimulant, immediately. Two hours later, the patient awoke. Laboratory tests revealed the following results： arterial oxygen partial pressure （ PaO2 ） 292 mmHg （ 1 mmHg -=0. 133 kPa）, lactic acid 5.70 mmoL/L, D-dimer 7.8 mg/L, plasma fibrinogen degradation product （FDP） 45 mg/L. Twenty-four hours later, laboratory tests revealed the following results： PaO2 98 mmHg, lactic acid 1.7 mmol/L, D-dimer 2.2 mg/L, FDP 19 mg/L. The trachea cannula was removed. Forty-eight hours later, his consciousness returned to normal. He could finish the common action. But he still had the symptom of drowsiness. Seven days later, the patient could answer questions accurately. His muscular tension returned to normal. He had light drowsiness occasionally.

关 键 词：中毒 丙戊酸 齐拉西酮 

分 类 号：R595.4[医药卫生—内科学]