血液灌流聯(lián)合機械通氣救治大劑量氯氮平中毒19例療效分析

葉興文+喻秋平+楊蕙文+李力+羅洋+劉松

【摘要】 目的：探討血液灌流聯(lián)合機械通氣治療大劑量氯氮平中毒的臨床療效。方法：回顧性分析本院ICU科在2010年7月-2014年4月收治的39例大劑量氯氮平中毒患者的臨床資料，比較血液灌流組（常規(guī)治療組加用樹脂吸附血液灌流）19例與常規(guī)治療組（機械通氣和對癥支持治療）20例的臨床療效，觀察比較血液灌流前后血漿氯氮平濃度、血漿N-去甲基氯氮平濃度的變化及兩組恢復清醒時間、機械通氣時間、升壓藥使用時間、住院時間及病死率等方面的差異。結果：與血液灌流前比較，血液灌流后的血漿氯氮平濃度、血漿N-去甲基氯氮平濃度均明顯下降，且與血液灌流次數(shù)相關，差異均有統(tǒng)計學意義（P<0.05）。血液灌流組的恢復清醒時間、機械通氣時間、升壓藥使用時間及住院時間均明顯短于常規(guī)治療組，差異均有統(tǒng)計學意義（P<0.05），而兩組病死率無明顯差異（P>0.05）。結論：血液灌流聯(lián)合機械通氣治療大劑量氯氮平中毒，患者恢復清醒時間、機械通氣時間、升壓藥使用時間和住院時間均縮短，適用于搶救大劑量氯氮平中毒的患者，值得臨床推廣。

【關鍵詞】 血液灌流； 機械通氣； 氯氮平中毒

Clinical Analysis of Hemoperfusion Combined with Mechanical Ventilation in Treatment of 19 Cases of Large Dose of Clozapine Poisoning/YE Xing-wen，YU Qiu-ping，YANG Hui-wen，et al.//Medical Innovation of China，2014，11（28）：079-082

【Abstract】 Objective： To investigate the clinical curative effect of hemoperfusion combined with mechanical ventilation in treatment of large dose of clozapine poisoning.Method：The clinical data of 39 patients with large dose of clozapine poisoning in our ICU department from July 2010 to April 2014 were retrospectively analyzed，they were randomly divided into the hemoperfusion group （routine treatment group added with resin hemoperfusion） for 19 cases and routine treatment group （mechanical ventilation and symptomatic and supportive treatment） for 20 cases.The differences in plasma clozapine concentration，N-norclozapine concentration before and after hemoperfusion and the time of the awake，mechanical ventilation，vasopressor use，hospitalization and mortality rate between the two groups were observed and compared.Result：Compared with before hemoperfusion，plasma clozapine concentration，N-norclozapine concentration after hemoperfusion were decreased significantly，and related to the number of blood perfusion，the differences were statistically significant（P<0.05）.The awake time，mechanical ventilation time，vasopressor use time and hospitalization time in hemoperfusion group were significantly shorter than those in routine treatment group，the differences were statistically significant（P<0.05），but there was no statistically significant difference in mortality rate of two groups（P>0.05）.Conclusion：Hemoperfusion combined with mechanical ventilation in treatment of large dose of clozapine poisoning can reduce the time of recover awake，mechanical ventilation vasopressor use and hospitalization，suitable for repairing the high-dose clozapine poisoning patients，is worth clinical promotion.

【Key words】 Hemoperfusion； Mechanical ventilation； Clozapine poisoning

First-authors address：The Affiliated Hospital of Jiujiang University，Jiujiang 332000，China

doi：10.3969/j.issn.1674-4985.2014.28.028

葉興文 喻秋平 楊蕙文 李力 羅洋 劉松endprint

【摘要】 目的：探討血液灌流聯(lián)合機械通氣治療大劑量氯氮平中毒的臨床療效。方法：回顧性分析本院ICU科在2010年7月-2014年4月收治的39例大劑量氯氮平中毒患者的臨床資料，比較血液灌流組（常規(guī)治療組加用樹脂吸附血液灌流）19例與常規(guī)治療組（機械通氣和對癥支持治療）20例的臨床療效，觀察比較血液灌流前后血漿氯氮平濃度、血漿N-去甲基氯氮平濃度的變化及兩組恢復清醒時間、機械通氣時間、升壓藥使用時間、住院時間及病死率等方面的差異。結果：與血液灌流前比較，血液灌流后的血漿氯氮平濃度、血漿N-去甲基氯氮平濃度均明顯下降，且與血液灌流次數(shù)相關，差異均有統(tǒng)計學意義（P<0.05）。血液灌流組的恢復清醒時間、機械通氣時間、升壓藥使用時間及住院時間均明顯短于常規(guī)治療組，差異均有統(tǒng)計學意義（P<0.05），而兩組病死率無明顯差異（P>0.05）。結論：血液灌流聯(lián)合機械通氣治療大劑量氯氮平中毒，患者恢復清醒時間、機械通氣時間、升壓藥使用時間和住院時間均縮短，適用于搶救大劑量氯氮平中毒的患者，值得臨床推廣。

【關鍵詞】 血液灌流； 機械通氣； 氯氮平中毒

Clinical Analysis of Hemoperfusion Combined with Mechanical Ventilation in Treatment of 19 Cases of Large Dose of Clozapine Poisoning/YE Xing-wen，YU Qiu-ping，YANG Hui-wen，et al.//Medical Innovation of China，2014，11（28）：079-082

【Abstract】 Objective： To investigate the clinical curative effect of hemoperfusion combined with mechanical ventilation in treatment of large dose of clozapine poisoning.Method：The clinical data of 39 patients with large dose of clozapine poisoning in our ICU department from July 2010 to April 2014 were retrospectively analyzed，they were randomly divided into the hemoperfusion group （routine treatment group added with resin hemoperfusion） for 19 cases and routine treatment group （mechanical ventilation and symptomatic and supportive treatment） for 20 cases.The differences in plasma clozapine concentration，N-norclozapine concentration before and after hemoperfusion and the time of the awake，mechanical ventilation，vasopressor use，hospitalization and mortality rate between the two groups were observed and compared.Result：Compared with before hemoperfusion，plasma clozapine concentration，N-norclozapine concentration after hemoperfusion were decreased significantly，and related to the number of blood perfusion，the differences were statistically significant（P<0.05）.The awake time，mechanical ventilation time，vasopressor use time and hospitalization time in hemoperfusion group were significantly shorter than those in routine treatment group，the differences were statistically significant（P<0.05），but there was no statistically significant difference in mortality rate of two groups（P>0.05）.Conclusion：Hemoperfusion combined with mechanical ventilation in treatment of large dose of clozapine poisoning can reduce the time of recover awake，mechanical ventilation vasopressor use and hospitalization，suitable for repairing the high-dose clozapine poisoning patients，is worth clinical promotion.

【Key words】 Hemoperfusion； Mechanical ventilation； Clozapine poisoning

First-authors address：The Affiliated Hospital of Jiujiang University，Jiujiang 332000，China

doi：10.3969/j.issn.1674-4985.2014.28.028

葉興文 喻秋平 楊蕙文 李力 羅洋 劉松endprint

【摘要】 目的：探討血液灌流聯(lián)合機械通氣治療大劑量氯氮平中毒的臨床療效。方法：回顧性分析本院ICU科在2010年7月-2014年4月收治的39例大劑量氯氮平中毒患者的臨床資料，比較血液灌流組（常規(guī)治療組加用樹脂吸附血液灌流）19例與常規(guī)治療組（機械通氣和對癥支持治療）20例的臨床療效，觀察比較血液灌流前后血漿氯氮平濃度、血漿N-去甲基氯氮平濃度的變化及兩組恢復清醒時間、機械通氣時間、升壓藥使用時間、住院時間及病死率等方面的差異。結果：與血液灌流前比較，血液灌流后的血漿氯氮平濃度、血漿N-去甲基氯氮平濃度均明顯下降，且與血液灌流次數(shù)相關，差異均有統(tǒng)計學意義（P<0.05）。血液灌流組的恢復清醒時間、機械通氣時間、升壓藥使用時間及住院時間均明顯短于常規(guī)治療組，差異均有統(tǒng)計學意義（P<0.05），而兩組病死率無明顯差異（P>0.05）。結論：血液灌流聯(lián)合機械通氣治療大劑量氯氮平中毒，患者恢復清醒時間、機械通氣時間、升壓藥使用時間和住院時間均縮短，適用于搶救大劑量氯氮平中毒的患者，值得臨床推廣。

【關鍵詞】 血液灌流； 機械通氣； 氯氮平中毒

Clinical Analysis of Hemoperfusion Combined with Mechanical Ventilation in Treatment of 19 Cases of Large Dose of Clozapine Poisoning/YE Xing-wen，YU Qiu-ping，YANG Hui-wen，et al.//Medical Innovation of China，2014，11（28）：079-082

【Abstract】 Objective： To investigate the clinical curative effect of hemoperfusion combined with mechanical ventilation in treatment of large dose of clozapine poisoning.Method：The clinical data of 39 patients with large dose of clozapine poisoning in our ICU department from July 2010 to April 2014 were retrospectively analyzed，they were randomly divided into the hemoperfusion group （routine treatment group added with resin hemoperfusion） for 19 cases and routine treatment group （mechanical ventilation and symptomatic and supportive treatment） for 20 cases.The differences in plasma clozapine concentration，N-norclozapine concentration before and after hemoperfusion and the time of the awake，mechanical ventilation，vasopressor use，hospitalization and mortality rate between the two groups were observed and compared.Result：Compared with before hemoperfusion，plasma clozapine concentration，N-norclozapine concentration after hemoperfusion were decreased significantly，and related to the number of blood perfusion，the differences were statistically significant（P<0.05）.The awake time，mechanical ventilation time，vasopressor use time and hospitalization time in hemoperfusion group were significantly shorter than those in routine treatment group，the differences were statistically significant（P<0.05），but there was no statistically significant difference in mortality rate of two groups（P>0.05）.Conclusion：Hemoperfusion combined with mechanical ventilation in treatment of large dose of clozapine poisoning can reduce the time of recover awake，mechanical ventilation vasopressor use and hospitalization，suitable for repairing the high-dose clozapine poisoning patients，is worth clinical promotion.

【Key words】 Hemoperfusion； Mechanical ventilation； Clozapine poisoning

First-authors address：The Affiliated Hospital of Jiujiang University，Jiujiang 332000，China

doi：10.3969/j.issn.1674-4985.2014.28.028

葉興文 喻秋平 楊蕙文 李力 羅洋 劉松endprint