急性钙通道阻滞剂中毒的临床特征研究  

Clinical Study of Characteristics of Acute Poisoning Caused by Calcium Channel Blockers

作　　者：李辉[1] 任珍 郭治国[1] LI Hui;REN Zhen;GUO Zhiguo(Emergency Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院急诊科,北京市100191

出　　处：《中国全科医学》2023年第14期1758-1765,共8页Chinese General Practice

摘　　要：背景 钙通道阻滞剂(CCBs)是我国最常用的一类降压药物,严重CCBs中毒死亡率高,但目前关于其临床特征的相关报道少。目的 通过总结11例急性CCBs中毒患者的临床表现及诊疗结果,分析急性CCBs中毒的临床特点以及血液净化治疗的价值。方法 回顾性分析2019年1月至2022年6月因CCBs急性中毒就诊于北京大学第三医院急诊科的11例患者的临床表现、症状评分、治疗经过及预后。结果 11例CCBs急性中毒患者中女3例,男8例;平均年龄(39.8±18.0)岁;服药至就诊的中位间隔时间为2.25(6.58)h;来诊时主要临床表现为休克9例(9/11),恶心、呕吐5例(5/11),头晕4例(4/11),乏力3例(3/11),心率增快3例(3/11),心率减慢2例(2/11),晕厥1例(1/11),昏睡1例(1/11)。10例(10/11)患者到达急诊时意识清楚[格拉斯哥昏迷量表(GCS)评分15分]。除了常规治疗,其中6例患者接受血液净化治疗,包括血液灌流联合血浆置换和连续性静脉-静脉血液滤过(CVVH)2例、血液灌流联合CVVH 2例、单独血液灌流2例。此6例中4例患者接受体外膜肺氧合(ECMO)治疗。接受首次血液净化治疗后复查CCBs血药浓度均有下降,硝苯地平下降比例(40.00%~63.64%)高于氨氯地平和维拉帕米(9.09%~26.67%)。11例患者出院时存活9例(9/11)。入院24 h中位急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)评分为10(25)分。入院时中位中毒严重度评分(PSS)为3(1)分。入院时PSS评分为3分的8例患者中死亡2例(2/8),入院时APACHEⅡ评分≥15分的5例患者中死亡2例(2/5)。结论 休克早期意识清晰是急性CCBs中毒较常见表现。在降低血药浓度方面,血液灌流在急性硝苯地平中毒中的作用可能优于在急性氨氯地平和维拉帕米中毒中的作用。APACHEⅡ评分在预测CCBs急性中毒的死亡预后方面可能优于PSS评分。Background Calcium channel blockers(CCBs) are the most commonly used class of antihypertensive drugs in China. Despite the high mortality rate of severe CCBs poisoning,few relevant reports on its clinical characteristics can be found currently. Objective To analyze the clinical characteristics of acute CCBs poisoning and the value of blood purification therapy by summarizing the clinical manifestations and treatment results of 11 patients with acute CCBs poisoning. Methods A retrospective analysis was conducted with regard to the clinical presentation,scores for condition assessment,treatment process and prognosis of 11 patients who presented to the Emergency Department,Peking University Third Hospital for acute CCBs poisoning from January 2019 to June 2022. Results Of the 11 patients,3 were female and 8 were male. The average age was(39.8±18.0) years and the median interval between drug administration and consultation was 2.25(6.58) hours. The main clinical manifestations at presentation were shock(9 cases,9/11),nausea and vomiting(5 cases,5/11),dizziness(4 cases,4/11),fatigue(3 cases,3/11),tachycardia(3 cases,3/11),bradycardia(2 cases,2/11),syncope(1case,1/11) and lethargy(1 case,1/11). Ten patients arrived at the ED with a clear consciousness(with a Glasgow Coma Score of 15 points). In addition to conventional treatment,6 of the patients received blood purification treatment,including hemoperfusion,plasma exchange and continuous veno-venous hemofiltration(CVVH) in 2 cases,hemoperfusion combined with CVVH in 2 cases,and hemoperfusion alone in 2 cases. Four of these 6 patients also received extracorporeal membrane pulmonary oxygenation therapy. The blood concentration of CCBs decreased after the first blood purification treatment,and the percentage of decrease was higher for nifedipine(40.00%-63.64%) than for amlodipine and verapamil(9.09%-26.67%).Nine of the 11 patients survived at discharge. The median Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)score at admission was 10(25) points. The median P

关 键 词：钙通道阻滞药 中毒 血药浓度 血液净化 临床评分 休克 体外膜肺氧合 

分 类 号：R792.3[医药卫生—临床医学]