急性缺血性卒中患者低温治疗中抗寒战药物不良反应的临床观察

Clinical observation of adverse reactions to antishivering drugs used for patients with acute ischemic stroke during hypothermia therapy

目的:观察急性缺血性卒中患者低温治疗中抗寒战药物的不良反应。方法:2005年11月1日至2007年8月30日期间,对发病3 d内的15例急性脑梗死患者进行了低温治疗,男10例,女5例,平均年龄(57±1)岁。其中体表低温10例,血管低温5例。所有患者在低温治疗前给予抗寒战药物。体表低温患者静脉推注负荷剂量氯丙嗪和异丙嗪各25 mg,随后各静脉持续泵入1～5 mg/h,并根据寒战程度调整剂量。血管内低温患者中非昏迷者先静脉推注负荷剂量哌替啶1 mg/kg和负荷剂量异丙嗪25 mg,后持续泵入哌替啶25～35 mg/h和异丙嗪1.5～3 mg/h,当患者出现1级寒战时,再次静脉推注哌替啶10～25 mg,并持续泵入哌替啶5 mg/h,直至寒战控制;昏迷患者静脉输注负荷剂量阿曲库铵0.4 mg/kg,并持续泵入5μg/(kg.min),最大剂量为45 mg/h。结果:15例患者中7例发生不良反应,发生率为46.7%。10例体表低温患者中,4例出现不良反应,其中2例为快速心房纤维颤动(154次/min及157次/min),2例血压下降[171/82降至97/50 mm Hg(1 mm Hg=0.133 kPa)及192/109降至113/87 mm Hg];5例血管内低温患者3例出现不良反应,其中1例出现呼吸频率减慢(8次/min),1例呼吸频率减慢同时伴心率减慢(77次/min)和血压下降(88/39 mm Hg),1例血压下降(57/39 mm Hg)。7例患者中除2例因快速心房纤维颤动不能纠正而终止体表低温治疗外,其余患者经对症处理不良反应消失。结论:抗寒战药物不良反应主要为心率变化和血压下降;多数反应较轻,不影响低温治疗。

Objective： To observe adverse reactions of antishivering drugs used for patients with acute ischemic stroke during hypothermia therapy. Methods： Between 1 November 2005 and 30 August 2007, 15 patient who had acute ischemic stroke with an onset time within 3 days received hypothermia therapy. The patients comprised 10 men and 5 women with mean age （57 ± 1 ） years. Of the 15 patients, 10 received surface cooling and 5 received endovascular cooling. All patients received antishivering drugs before hypothermia therapy. The patients receiving surface cooling were administered with an IV push of a loading dose of chlorpromazine 25 mg and a loading dose of promethazine 25 mg, followed by a continuous infusion pump delivering 1-5 mg/h of chlorpromazine and promethazine, and then their dosage was adjusted according to the grade of shivering. The patients, who received endovascular cooling and was not in a coma, were administered with an IV push of a loading dose of pethidine 1 mg/kg and a loading dose of promethazine 25 mg, followed by a continuous infusion pump delivering pethidine 25-35 mg/h and promethazine 1.5-3 mg/h; when patients developed grade 1 shivering, an IV push of pethidine 10-25 mg was given again, followed by a continuous infusion pump delivering pathidine 5 mg/L until the shivering was controlled. The patients, who received endovascular cooling and was in a coma, was administered with an IV infusion of. a loading dose of atracurium 0.4 mg/kg, followed by a continuous infusion pump delivering 5 μg/（kg · min） ; the maximum dose was 45 mg/h. Results： Adverse reactions occurred in 7 of 15 patients （46.7%）. Of the 10 patients receiving surface cooling, 4 developed adverse reactions including 2 cases of rapid atrial fibrillation （ 154 beats/min and 157 beats/min） and 2 cases of decreased blood pressure （from 171/82 mm Hg to 97/50 mm Hg and from 192/109 mmHg to 113/87 mm Hg）. Of the 5 patients receiving endovaseular cooling, 3 presented with adverse reactions including 1 ease of decreased respiratory rate （8 breaths/rain） and 1 case of decreased respiratory rate with decreased heart rate （77 beats/rain） and decreased blood pressure （88/39 mm Hg）, 1 ease of decreased blood pressure （57/39 mm Hg）. Of the 7 patients who experienced adverse reactions, 5 recovered after symptomatic treatment and 2 did not complete their hypothermia therapy due to rapid atrial fibrillation. Conclusion： Adverse reactions of antishivering drugs are mainly heart rate change and decreased blood pressure ; most of them are mild and do not affect the hypothermia therapy.