摘要
目的:探讨地西泮中毒急救患者的脂肪乳应用剂量,以指导临床合理用药。方法:选择2013年10月至2015年10月来广西医科大学第八附属医院急诊科就诊的88例急性地西泮中毒患者作为观察组,根据患者的中毒情况分为轻度中毒组(32例)、中度中毒组(31例)和重度中毒组(25例),每组患者再分为两个亚组,即10%脂肪乳治疗组和20%脂肪乳治疗组。另选取采用纳洛酮治疗的急性地西泮中毒患者30例作为阳性对照组。记录各组患者在治疗前0.5h和治疗后各时间段地西泮的血药浓度,同时记录患者的苏醒时间和住院时间。监测治疗前、后患者的Ramsay镇静深度评分。统计不良反应和并发症发生情况。结果:观察组中,接受20%脂肪乳治疗的患者苏醒时间、住院时间、Ramsay镇静深度评分均优于接受10%脂肪乳治疗的患者(P<0.05),且与阳性对照组比较差异无统计学意义(P>0.05);与治疗前相比,治疗后短时间内地西泮的血药浓度明显降低,且20%脂肪乳治疗组患者浓度低于10%脂肪乳治疗组患者(P<0.05)。所有患者均未出现严重并发症,随访过程中也未发现患者出现反跳现象。结论:使用不同浓度的脂肪乳可以在短时间内明显降低地西泮中毒患者的血药浓度,起到治疗急性中毒的作用,其中20%浓度的脂肪乳效果更为良好。
Objective： To explore the proper dose of fat emulsion application in emergency patients with acute diazepam poisoning （ADP）. Methods： 88 patients with ADP treated in our hospital from October 2013 to October 2015 were selected and divided into the mild- （ n =32）, moderate- （ n =31） and severe- （ n = 25） poisoning groups according to the poisoning degree. Each group of patients were then randomized into 2 sub-groups： 10% fat emulsion i. v. treatment group and 20% fat emulsion i. v. treatment group. 30 ADP patients who received naloxone treatment were enrolled as a positive control group. The serum concentrations of diazepam at 0.5 h pretreatment and at different time-points post-treatment were recorded. The recovery time, hospital days, adverse reactions, and complications as well as Ramsay Sedation Scale （RSS） score were also recorded before and after treatments. Results： The recovery time, hospital days and RSS score in patients treated with 20% fat emulsion were better than those treated with 10% fat emulsion （ P 〈0.05）, and were not significant different from those in the positive control group （ P 〈0.05）. Plasma concentration of diazepam was significant decreased after treatment, and the reduction was more significant in patients who received 20% fat emulsion than those received 10% fat emulsion （ P 〈0.05）. No severe complications were noted in all patients. No rebound phenomenon was found during followed-up. Conclusion： Application of different concentrations of fat emulsion could markedly reduce the plasma concentration of diazepam in patients with ADP in a short period of time, and 20% of fat emulsion was more effective.
作者
陈天山
Chen Tianshan.(Emergency Department, The Eighth Affiliated Hospital of Guangxi Medical University, Wuzhou 543001, China)
出处
《广西医科大学学报》
CAS
2017年第2期247-251,共5页
Journal of Guangxi Medical University
关键词
地西泮中毒
脂肪乳剂
镇静深度评分
diazepam poisoning
fat emulsion
depth of sedation score
