劳拉西泮致服用氢溴酸西酞普兰等多种药物的尿毒症患者呼吸衰竭死亡

Respiratory failure and death from lorazepam in a patient with uremia receiving citalopram hydrobromide and various other medications

1例65岁男性患尿毒症、高血压、粟粒性肺结核、抑郁症等疾病接受多种药物治疗,因焦虑症晚间睡前口服氢溴酸西酞普兰30 mg,次日晨口服劳拉西泮0.5 mg。2 h后患者出现精神萎靡,呼吸浅弱,双下肺呼吸音消失,反复大汗。血气分析示pH 7.16,二氧化碳分压80 mm Hg,氧分压134 mm Hg。先后予尼可刹米、洛贝林、氟马西尼,并行血液透析加灌流,呼吸机辅助通气,救治3 d症状无好转,第4天晨终因呼吸、循环衰竭死亡。

A 65-year-old man with uremia, hypertension, miliary tuberculosis, depression and other diseases received muhiple drug therapy. He was given oral citalopram hydrobromide 30 mg at bedtime and oral lorazepam 0.5 mg in the next morning for anxiety. Two hours later, the patient developed mental fatigue, hypopnea, absent breath sounds in bilateral lungs, hyperhidrosis. Blood gas analysis showed the following levels： pH 7.16, PaCO2 80 mm Hg, PaO2 134 mm Hg. The patient was given nikethamide, lobeline, and flumazenil and underwent hemodialysis, hemoperfusion, and assisted mechanical ventilation. He had no improvement in symptoms despite a 3-day resuscitation attempts and died from respiratory and circulatory failure on the fourth day.