精神分裂症患者肠梗阻合并感染致氯氮平血药浓度异常增高1例  

A case of abnormally increased clozapine plasma concentration caused by ileus and infections in a patient with schizophrenia

作　　者：顾艺 薄奇静 张艳芳 李田 王传跃 Gu Yi;Bo Qijing;Zhang Yanfang;Li Tian;Wang Chuanyue(The National Clinical Research Center for Mental Disorders,Beijing Key Laboratory of Mental Disorders,Beijing Institute for Brain Disorders Center of Schizophrenia,Beijing Anding Hospital,Capital Medical University,Beijing 100088,China)

机构地区：[1]首都医科大学附属北京安定医院精神疾病诊断与治疗北京市重点实验室、国家精神心理疾病临床医学研究中心、北京脑重大疾病研究院精神分裂症研究所,北京100088

出　　处：《中华精神科杂志》2023年第3期227-231,共5页Chinese Journal of Psychiatry

摘　　要：本文报道了1例长期应用氯氮平治疗的51岁精神分裂症患者出现肠梗阻合并感染,随后发现其氯氮平血药浓度异常增高达3094.80μg/L(正常范围350~600μg/L),伴肺部感染,停用氯氮平、予静脉补液及抗生素治疗后病情好转。本文中对已报道的16例感染合并氯氮平血药浓度异常增高的病例进行了文献回顾。氯氮平使用者应监测血常规和氯氮平血药浓度,及时处理不良反应。针对有感染症状而白细胞正常的氯氮平使用者,应综合考虑中性粒细胞比例、C反应蛋白等其他指标,合理应用抗生素治疗。如发现氯氮平血药浓度异常增高,可停用氯氮平,静脉补液促进氯氮平排出,病情平稳后可尝试复用氯氮平。A 51-year-old schizophrenic patient with long-term clozapine treatment developed intestinal obstruction combined with infection.Subsequently,the patient′s clozapine plasma concentration abnormally increased to 3094.80μg/L(reference range 350-600μg/L),accompanied with pulmonary infection.Patient′s symptoms showed significant improvement after clozapine was discontinued,along with intravenous fluid reinfusion and antibiotic treatment.This current article also provided a literature review of 16 reported cases of infection with abnormally elevated clozapine plasma concentration.Clozapine plasma concentration and blood routine should be monitored in clozapine users,and adverse reactions should be treated in time.For clozapine users with infection but normal leukocyte count,multiple bacterial infection indicators such as the neutrophil proportion and C-reactive protein should begiven comprehensive consideration,and antibiotics should be used when appropriate.If clozapine plasma concentration is abnormally high,clozapine can be discontinued and intravenous fluid reinfusion can accelerate clozapine elimination.After the patient′s condition stabilizes,clozapine could be reused.

关 键 词：精神分裂症 肠梗阻 氯氮平 感染 白细胞减少 血药浓度 

分 类 号：R969.1[医药卫生—药理学]