血液灌流和纳洛酮治疗氯氮平中毒效果观察

目的 探讨血液灌流和纳洛酮治疗氯氮平中毒的临床效果.方法 将内蒙古医科大学附属医院2007年8月至2014年4月救治的41例急性氯氮平中毒患者据治疗方式不同分为常规治疗组（20例）、血液灌流和纳洛酮治疗组（21例）.常规治疗组患者入院后给予洗胃、利尿、导泻、保护脏器功能等治疗,血液灌流和纳洛酮治疗组患者在上述常规治疗基础上,用HA230灌流器以150 ～ 200 ml/min流速血液灌流2h,血液灌流后在4h内静脉滴注纳洛酮0.5 mg/kg.观察并比较2组患者治疗5d后病死率、昏迷时间和并发症发生率.结果 常规治疗组和血液灌流和纳洛酮治疗组病死率分别为10.0％ （2/20）和4.7％（1/21）,组间差异无统计学意义（P＞0.05）;昏迷时间分别为（30±14）h和（19±10）h,组间差异有统计学意义（P＜0.05）.常规治疗组中有8例患者（44.4％）出现吸入性肺炎,血液灌流和纳洛酮组中仅有1例（6.2％）出现吸入性肺炎,组间差异有统计学意义（P＜0.05）.血液灌流和纳洛酮组和常规治疗组其他并发症如肝功能异常、心肌酶学异常、心功能不全、低血压、癫（痫）发作、深静脉穿刺部位出血、血小板减少发生率,差异均无统计学意义19.0％（4/21）比25.0％（5/20）,38.1％（8/21）比35.0％（7/20）,19.0％（4/21）比15.0％（3/20）,23.8％ （5/21）比10.0％（2/20）,9.5％（2/21）比10.0％（2/20）,23.8％ （5/21）比0.0,9.5％（2/21）比0.0]（均P＞0.05）.结论 血液灌流和纳洛酮联合治疗可缩短氯氮平中毒患者昏迷时间,降低吸入性肺炎并发症发生率.

Curative effect of hemoperfusion and naloxone in the treatment of clozapine poisoning

Objective To discuss the curative effect of hemoperfusion and naloxone in the treatment of clozapine poisoning.Methods Totally 34 patients with clozapine poisoning from August 2008 to April 2014 were divided into two groups.There were 20 patients in the routine treatment group and 21 patients in the hemoperfusion and naloxone treatment group.The patients were treated with gastric lavage,dieresis,catharsis and protection of liver function in the routine treatment group.The patients of hemoperfusion and naloxone treatment group had hemoperfusion,HA230 and naloxone after routine treatment.The mortality,coma time and the complication of aspiration pneumonia in the two groups before treatment and after 5 days were observed and analyzed.Results The mortalities of two groups were 10.0% （2/20） in the routine treatment group and 4.7% （1/21） in the hemoperfusion and naloxone treatment group（P 〉 0.05）.The average coma time of two groups was （30 ± 14）h in the routine treatment group and （19 ± 10） h in the hemoperfusion and naloxone treatment group （P 〈 0.05）.8 patients （44.4%） had aspiration pneumonia in the routine treatment group,but only 1 patient（6.2%） had it in the hemoperfusion and naloxone treatment group（P 〈0.05）.Coma time and the complication of aspiration pneumonia in the hemoperfusion and naloxone treatment group were significantly lower than those in the routine treatment group （P 〈 0.05）.There were no statistically significant differences in the incidence rate of other complications such as the abnormal liver function,myocardial enzymology,cardiac insufficiency,low blood pressure,seizures,deep vein puncture bleeding and thrombocytopenia,between blood perfusion and naloxone group and conventional treatment group 19.0 % （4/21） vs 25.0% （5/20）,38.1% （8/21） vs 35.0% （7/20）,19.0% （4/21） vs 15.0% （3/20）,23.8% （5/21） vs 10.0% （2/20）,9.5% （2/21） vs 10.0% （2/20）,23.8% （5/21） vs 0.0,9.5% （2/21） vs 0.0] （all P 〉 0.05）.C