1例舍曲林中毒致癫痫样发作伴肝损害的诊治  

Diagnosis and treatment of one case of epileptiform seizure with liver injury resulted from sertraline poisoning

作　　者：伊朋 徐甲瑞 张伟 张兴国 冯宝宝 YI Peng;XU Jiarui;ZHANG Wei;ZHANG Xingguo;FENG Baobao(Emergency Center,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院急救中心中毒与职业病科,山东济南250021

出　　处：《山东医药》2025年第3期122-125,共4页Shandong Medical Journal

基　　金：山东省医药卫生科技发展计划项目(2017WS096)。

摘　　要：目的分析1例舍曲林中毒致癫痫样发作伴肝损害的诊断及治疗过程,旨在为此类疾病的救治提供参考。方法对1例因舍曲林中毒致癫痫样发作伴肝损害患者的诊断及治疗过程作回顾性分析。结果患者男,15岁,因学习压力大故意口服盐酸舍曲林片(50 mg/片)20片,约40 min后出现头晕、心慌、恶心,给予催吐、药用炭吸附、甘露醇导泻、复方甘草酸苷保肝等治疗。全血有机毒物测定结果显示:舍曲林血药浓度246.10μg/L。患者肝功能指标轻度升高,且存在恶心、乏力症状,考虑为药物所致肝损害。患者服药38 h后开始出现呼吸急促、心率加快、全身颤抖、抽搐、四肢强直、意识丧失等癫痫样发作症状,初始应用地西泮效果尚可,后疗效变差,改为咪达唑仑联合丙戊酸钠泵入,症状明显改善,接受三次血液灌流治疗后舍曲林血药浓度显著下降。患者病情明显好转后转院。结论远超治疗剂量的舍曲林中毒后可引起癫痫样发作伴肝损害,催吐、药用炭吸附、血液灌流等治疗措施可降低舍曲林血药浓度、改善肝损害,地西泮、咪达唑仑联合丙戊酸钠可用于癫痫样发作的治疗。Objective To analyze the diagnosis and treatment of one case of epileptiform seizure with liver injury resulted from sertraline poisoning,aiming to provide reference for the treatment of similar diseases.Methods A retrospective analysis was made on the diagnosis and treatment of a case of epileptiform seizure with liver injury resulted from sertraline poisoning.Results A 15-year-old male deliberately took 20 tablets of sertraline hydrochloride(50 mg/tablet)orally due to high academic pressure.He developed dizziness,palpitation,and nausea 40 minutes later,and received emetic,adsorption with medicinal carbon,catharsis with mannitol,liver protection and other supportive treatments.The blood concentration of sertraline was 246.10μg/L.Drug-induced liver injury was diagnosed based on the elevated transaminase level and the symptoms of nausea and fatigue.The patient developed epileptiform symptoms including tachypnea,tachycardia,tremble,convulsion,limbs rigidity,and loss of consciousness 38 h after medication.Diazepam was used to control the symptoms,and the effect was satisfied in the beginning.When the effect of diazepam became poor,continuous intravenous administration of midazolam and valproate were conducted,and the symptoms were significantly improved.The blood concentration of sertraline decreased significantly when the patient received hemoperfusion treatments for three times.The patient was transferred to a psychiatric hospital after his condition improved.Conclusions Poisoning with sertraline could lead to epileptiform seizure with liver injury when the dose was far beyond the therapeutic range.Emetic,adsorption with medicinal carbon,hemoperfusion and supportive treatments can reduce the blood concentration of sertraline and reduce liver injury.Diazepam,midazolam and valproate can be used for the treatment of epileptic seizures.

关 键 词：舍曲林 药物中毒 癫痫样发作 肝损害 

分 类 号：R459.7[医药卫生—急诊医学]