CAJ | 학술논문

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。
목적：탐토혈액관류연합궤계통기치료대제량록담평중독적림상료효。방법：회고성분석본원ICU과재2010년7월-2014년4월수치적39례대제량록담평중독환자적림상자료，비교혈액관류조（상규치료조가용수지흡부혈액관류）19례여상규치료조（궤계통기화대증지지치료）20례적림상료효，관찰비교혈액관류전후혈장록담평농도、혈장N-거갑기록담평농도적변화급량조회복청성시간、궤계통기시간、승압약사용시간、주원시간급병사솔등방면적차이。결과：여혈액관류전비교，혈액관류후적혈장록담평농도、혈장N-거갑기록담평농도균명현하강，차여혈액관류차수상관，차이균유통계학의의（P<0.05）。혈액관류조적회복청성시간、궤계통기시간、승압약사용시간급주원시간균명현단우상규치료조，차이균유통계학의의（P<0.05），이량조병사솔무명현차이（P>0.05）。결론：혈액관류연합궤계통기치료대제량록담평중독，환자회복청성시간、궤계통기시간、승압약사용시간화주원시간균축단，괄용우창구대제량록담평중독적환자，치득림상추엄。
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.