脂肪乳对地西泮中毒患者血液浓度影响的临床观察

Clinical study on the change of blood concentration of diazepam in the patients of diazepam intoxication treated with lipid infusion

目的 观察脂肪乳对地西泮中毒的血药浓度影响及临床疗效.方法用20%脂肪乳250 mL治疗5例地西泮中毒患者,动态监测Ramsay镇静深度评分和地西泮血药浓度,比较治疗前后不同时间点Ramsay镇静深度评分、地西泮实测血药浓度与理论代谢浓度之间的差异.结果 脂肪乳治疗2 h后,患者血液地西泮浓度有显著降低,治疗前后中毒药物浓度下降幅度远远大于其理论代谢状态下的下降幅度（554.6±369.4 vs 1883.6±811.5,P=0.002）,治疗前后不同时间段Ramsay镇静深度评分差异有统计学意义[F=27.30;P=0.000;P=0.001（治疗前vs治疗后2 h）;P=0.000（治疗前vs治疗后20 h）;P=0.009（治疗后2 h vs治疗后20 h）].结论 小样本资料观察发现,脂肪乳可在短时间内显著降低地西泮血药浓度,改善中毒患者的意识状态,是值得进一步深入研究的脂溶性药物中毒潜在解毒剂.

Objective To observe the curative effect and change of blood concentration of diazepam in the patients with diazepam intoxication treated with lipid infusion. Methods Five patients with diazepam intoxication treated with 250 mL of 20% lipid infusion, the blood concentration of diazepam and Ramsay score were dynamically monitored before treatment and after 2 - hour, 20 - hour treatment respectively. On all of the time points, Ramsay score and the differences between actual blood concentration of diazepam and theoretic blood concentration were compared respectively. Results After 2 hours treated with 20% lipid infusion, the blood concentration of diazepam had significantly decreased, and the decreases in actual blood concentration group were greater than those in theoretic group（554.6 ± 369.4 vs 1883.6 ± 811.5, P = 0. 002）. Ramsay scores had significant differences among all of the time points （ F = 27.30 ; P = 0. 000 ; P = 0.001 for before treatment and after 2 - hour treatment; P = 0. 000 for before treatment and after 20 - hour treatment ; P = 0. 009 for after 2 - hour treatment and 20 - hour treatment）. Conclusion By observing a small sample of diazepam intoxication cases, diazepam concentration could be significantly decreased, and consciousness state is improved by treated with 20% lipid infusion, and it may be further studied as a potential antidote for liposoluble medicine intoxication.