血液灌流联合机械通气抢救氯氮平重度中毒患者的临床研究

Clinical Study of Hemoperfusion Combined Mechanical Ventilation in Treatment of Patients with Severe Clozapine Poisoning

目的探析血液灌流联合机械通气在氯氮平重度中毒患者临床抢救中的应用效果。方法将我院收治的78例氯氮平重度中毒患者随机分为观察组(40例)和对照组(38例)。对照组采取综合治疗及机械通气进行抢救,观察组在对照组的基础上给予血流灌注,比较两组患者治疗前后血浆药物水平、病死率、机械通气时间、恢复清醒时间以及住院时间。结果治疗后,两组血浆氯氮平浓度及血浆N-去甲基氯氮平浓度均显著降低,且观察组降低幅度显著大于对照组,差异具有统计学意义(P<0.05)。观察组机械通气时间、恢复清醒时间、住院时间均明显短于对照组,差异具有统计学意义(P<0.05)。观察组病死率和并发症发生率分别为0.0%和60.0%,与对照组的5.3%和57.9%相比无显著差异(P>0.05)。结论氯氮平重度中毒患者采取血液灌流联合机械通气进行抢救可有效清除体内毒素,缩短机械通气时间及恢复清醒时间,改善患者预后。

Objective To explore the application effect of hemoperfusion combined mechanical ventilation in clinical rescue of patients with severe clozapine poisoning. Methods 78 cases of patients with severe clozapine poisoning treated in our hospital were randomly divided into observation group （40 cases） and control group （38 cases）. The control group was given comprehensive treatment and mechanical ventilation for rescuing, the observation group was given hemoperfusion on the basis of control group. The plasma drug level, mortality, mechanical ventilation time, recovery time and hospitalization time of two groups were compared. Results After treatment, the concentrations of clozapine and N-desmethylclozapine in plasma of two groups were significantly decreased, and the reduction of observation group was greater than that of control group, with statistical difference （P〈0.05）. The mechanical ventilation time, recovery time and hospitalization time of observation group were shorter than those of control group, with statistical difference （P〈0.05）. The mortality and complications rates of two groups had no statistical difference （0.0%vs 5.3%, 60.0%vs 57.9%,P〉0.05）. Conclusions For patients with severe clozapine poisoning, hemoperfusion combined mechanical ventilation can effectively eliminate the toxin in the body, reduce mechanical ventilation time and recovery time, and also improve the prognosis of patients.