小剂量氯氮平中毒致多系统损害一例误诊分析  

Analysis of Misdiagnosis of One Case of Multiple System Damage Due to Intoxication Induced by Low-dose Clozapine

作　　者：林进皇 洪春永[1] 吴欣宇[1] 曾友福[1] 卢武生[1] LIN Jin-huang;HONG Chun-yong;WU Xin-yu;ZENG You-fu;LU Wu-sheng(Department of Neurology,175 Hospital of PLA,Zhangzhou,Fujian 363000,China)

机构地区：[1]解放军第一七五医院暨厦门大学附属东南医院神经内科,福建漳州363000

出　　处：《临床误诊误治》2018年第3期26-29,共4页Clinical Misdiagnosis & Mistherapy

基　　金：中国人民解放军第一七五医院青年苗圃基金项目(16Y001)

摘　　要：目的探讨小剂量氯氮平中毒的临床特征和诊治要点。方法对我院收治并误诊的小剂量氯氮平致重症中毒1例的临床资料进行回顾性分析。结果本例因意识不清伴口角抽搐、流涎4 h入院。患精神分裂症10年,长期规律口服氯氮平50 mg、2/d。急诊行头颅MRI检查未见异常,胸部CT提示双肺对称性弥漫性高密度改变,腰椎穿刺脑脊液压力为300 mm Hg,初步考虑癫痫持续状态、颅内感染、肺部感染。经治疗后意识转清,追问病史得知,发病前曾口服氯氮平100 mg,故确诊为小剂量氯氮平中毒,予利尿、降颅压、抗胆碱、气管插管、呼吸机辅助呼吸等综合治疗后好转出院。结论小剂量氯氮平可致多系统损害,提高认识、综合分析、及时行相关医技检查是减少误诊误治的关键。Objective To discuss clinical features and treatment measures of low-dose Clozapine intoxication.Methods The clinical data of a case suffering grave intoxication induced by low-dose Clozapine and misdiagnosed in our hospital were retrospectively analyzed.Results The patient was admitted to hospital for coma with mouth convulsion and salivation for 4 h and schizophrenia for ten years.He received long-term Clozapine(50 mg,2 times/d)treatment on a regular basis.Brain MRI was unremarkable,however,chest CT showed increased markings in both lungs.Additionally,intracranial pressure monitored by lumbar puncture was 300 mmHg.Thus,he was initially misdiagnosed with status epilepticus,intracranial infection and pulmonary infection.The patient waking up after symptomatic treatment stated that he had taken Clozapine 100 mg before onset.The final diagnosis was Clozapine intoxication and the patient gradually improved and was discharged after comprehensive treatment including diuretics,reducing intracranial pressure,cholinolytics,tracheal intubation and assisted mechanical ventilator.Conclusion Given association between low-dose Clozapine and multisystem damage,heightened perceptions of the disease,comprehensive analysis and timely medical examinations are key to reducing misdiagnosis.

关 键 词：中毒 氯氮平 误诊 癫痫持续状态 

分 类 号：R595.9[医药卫生—内科学]