氯氮平致肠梗阻造成患者死亡的文献分析

Literature review on the death of patients with intestinal obstruction induced by clozapine

目的:探讨抗精神病药物氯氮平引发肠梗阻造成患者死亡的临床特征、发生原因及预防治疗措施。方法:以"氯氮平"、"肠梗阻"、"clozapine AND intestinal obstruction"为主题词检索CNKI、Pub Med及Cochrane Library数据库,选择患者死亡前出现过肠梗阻,或死因怀疑与肠梗阻直接有关的病例,对患者的用药情况、肠梗阻的临床表现、用药关联性、死亡原因等进行分析。结果:共筛选有效文献11篇,有效病例19例。氯氮平引起的肠梗阻常见于高剂量长期给药的患者,具有剂量依赖性。79%的死亡患者均为较高剂量甚至超剂量给药。结论:在临床应用氯氮平过程中应密切监测患者的体征,有肠梗阻、便秘等症状的患者,氯氮平应减量,给予替换药物、对症治疗,甚至采取肠切除术等措施以降低患者的死亡率。

Objective： To investigate the clinical features, causes, preventive measures and treatments of intestinal obstruction induced by clozapine which results in death. Methods： CNKI, PubMed and Cochrane Library data base were retrieved by using the key words of clozapine and intestinal obstruction. Death cases directly related to intestinal obstruction or had the syndrome before death were included. The situation of drug applications, the clinical manifestations, the drug-related analysis and the causes of death were analyzed. Results： A total of 11 articles were included with 19 valid cases. Clozapine-induced intestinal obstruction was common in patients with long-term and high-dose administration, which showed dose dependent characteristic. About 79% patients who died received higher doses or over doses. Conclusion： Vital signs should be paid more attention to during clozapine treatment. Once intestinal obstruction or constipation symptoms occurred, in order to reduce the mortality rate, dosage of clozapine should be decreased immediately, replacement drugs should be given, symptomatic treatment even enterectomy surgery should be applied.