血液灌流联合机械通气救治大剂量氯氮平中毒19例疗效分析

目的：探讨血液灌流联合机械通气治疗大剂量氯氮平中毒的临床疗效。方法：回顾性分析本院ICU科在2010年7月-2014年4月收治的39例大剂量氯氮平中毒患者的临床资料,比较血液灌流组（常规治疗组加用树脂吸附血液灌流）19例与常规治疗组（机械通气和对症支持治疗）20例的临床疗效,观察比较血液灌流前后血浆氯氮平浓度、血浆N-去甲基氯氮平浓度的变化及两组恢复清醒时间、机械通气时间、升压药使用时间、住院时间及病死率等方面的差异。结果：与血液灌流前比较,血液灌流后的血浆氯氮平浓度、血浆N-去甲基氯氮平浓度均明显下降,且与血液灌流次数相关,差异均有统计学意义（P〈0.05）。血液灌流组的恢复清醒时间、机械通气时间、升压药使用时间及住院时间均明显短于常规治疗组,差异均有统计学意义（P〈0.05）,而两组病死率无明显差异（P〉0.05）。结论：血液灌流联合机械通气治疗大剂量氯氮平中毒,患者恢复清醒时间、机械通气时间、升压药使用时间和住院时间均缩短,适用于抢救大剂量氯氮平中毒的患者,值得临床推广。

Clinical Analysis of Hemoperfusion Combined with Mechanical Ventilation in Treatment of 19 Cases of Large Dose of Clozapine Poisoning

Objective： To investigate the clinical curative effect of hemoperfusion combined with mechanical ventilation in treatment of large dose of elozapine 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 ciozapine 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.