复方苯乙哌啶中毒34例临床分析

Clinical Analysis of 34 Cases with Compound Diphenoxylate Overdosage

目的分析小儿复方苯乙哌啶中毒的临床表现，纳洛酮在其中毒时的救治方法以及如何预防。方法收集、整理、分析2007年1月-2010年7月收治的34例复方苯乙哌啶中毒患儿的临床资料。中毒患儿给予纳洛酮首次剂量0．03～0．05mg/kg静脉推注治疗，根据病情严重程度可于2h后重复使用；重度患儿于首次注射后改静脉滴注维持2～3d，剂量为10～20μg（kg·h）。结果轻症复方苯乙哌啶中毒可引起发热、精神差、嗜睡、呕吐、腹胀、便秘等，重者可引起昏迷、抽搐、呼吸抑制、循环衰竭甚至脑出血、死亡。应用特效解毒药纳洛酮治疗，1例超大剂量误服患儿给予气管插管、呼吸机辅助通气，经治疗后好转，其余33例均治愈，治愈率97％。结论复方苯乙哌啶治疗小儿腹泻安全范围小，不良反应大，临床对小儿应禁用或慎用。早期诊断，早期使用纳洛酮，是复方苯乙哌啶中毒抢救成功的关键。

Objective To analyze the clinical manifestation, the effect of naloxone on children with overdosage of Compound Diphenoxylate and the prevention of children from intoxication. Methods The clinical data of 34 cases with Compound Diphenoxy- late overdosage who were treated in hospital from January 2007 to July 2010 were collected, arranged and analyzed. First dosage of naloxone 0, 03 - 0. 05 mg/kg were given by intravenous injection and can be given again 2 hours later when it was necessary according to the patient＇ s condition. If it was sever,naloxone 10 -20 μg/（ kg ·h） should be given by intravenous drip and stopped in 2 to 3 days conditionally. Results Slight cases with Compound Diphenoxylate overdosage caused fever,lethargy, hypersomnia, vomlting,abdominal distention, and constipation, et al. Severe cases caused coma, convulsion, respiratory depression, circulatory collapse even cerebral hemorrhage and death. Using Naloxone for treatment, a case with exceed overdosage child was given tracheal cannula and assisted ventilation by respirator and finally got better post-treatment. All of the others were cured. The cure rate was 97%. Conclusion Compound Diphenoxylate had small safety range and more adverse effects in treating children with diarrhea, so it was banned or used with caution. Early diagnosis and using Naloxone earlier was the key of treating children with Compound Diphenoxylate overdosage.