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血液灌流救治急性奥氦平中毒一例
儿科
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王医师![](data:image/png;base64,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)
![](data:image/png;base64,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)
河北省儿童医院
主诉 病史
患儿,女,3岁,因“误服奥氮平10 h”入院。患儿10 h前误服奥氮平24片(5 mg/片),服后随即出现晕倒,呼之不应,无呕吐及抽搐,无气促及面色青紫,急送当地医院予洗胃、补液等对症处理后患儿症状无改善,遂转入我院。
查体 复查
查体:被动体位,急性面容,表情淡漠,反应差,双侧瞳孔等大等圆,直径约2.5 mm,对光反射迟钝。颈软无抵抗。心音有力,律不齐,无病理性杂音。四肢无自主活动、肌力Ⅲ级,肌张力低,病理反射未引出。
血常规:RBC 4.85 x 1012/L,WBC8.7 X 109/L,Hb 92/L,PLT 256×109/L;血生化:ALT 18 U/L,AST 42 U/L,CK 114 U/L,CK-MB 17 U/L,Cr 8 umol/L。心电图:窦性心律不齐。
诊断 治疗
诊断:奥氮平中毒。入院后予补液、护肝、血液灌流治疗。第1次血液灌流后,患儿意识恢复,反应好,但仍呈嗜睡状态。并分别在入院后第7小时、第24小时进行了第2、第3次血液灌流。3次血液灌流治疗后,患儿神智转清,对答自如,复查血、尿常规及肝、肾功能均正常。住院4 d后出院。
随访 处理
本例患儿虽然经过洗胃及对症治疗,但是病情仍有可能恶化,因为溶解在体内脂肪组织中的药物会持续释放入血,引起血药浓度持续升高。血液灌流能有效地降低体内游离药物的浓度,促进在体内重要功能部位已结合的药物释放,提高清除效率,促进患儿的恢复。DOI:10.3760/cma.j.issn.1673—4912.2013.06.015
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共2评论最早评论
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匿名用户
很完整的病例,以后在临床中会注意到药物中毒除了洗胃还要设法降低血药浓度,奥氮平中毒没有什么可以中和毒性的药物吗?
2015-06-24 12:46
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张杰![](data:image/png;base64,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)
北京医院
误服原因呢?家里有小孩子药一定要保存好
2015-08-24 18:02
没有更多数据了