氯氮平致麻痹性肠梗阻伴急性肾功能不全

Paralytic ileus combined with acute renal insufficiency induced by clozapine

1例64岁男性患者因偏执型精神分裂症口服氯氮平6年，剂量为125 mg、2次/d，由于病情出现反复，专科医师将剂量改为250 mg、2次/d。加量用药约1个月，患者出现腹痛、腹胀、恶心、呕吐、少尿，遂自行停用氯氮平。停药2d后就诊于我院急诊科，体格检查见腹部膨隆，全腹压痛，肠鸣音弱；实验室检查示scr 106μmol/L，BUN 11.2 mmol/L；腹部X线片示小肠扩张伴多发阶梯状气液平。考虑为麻痹性肠梗阻，给予禁食、补液、抗炎、胃肠减压等综合治疗。次日患者肾功能不全加重， scr 606μmol/L，BUN 26.2 mmol/L，当日查氯氮平血药浓度为630μg/L。考虑麻痹性肠梗阻伴急性肾功能不全为氯氮平所致，将患者收入院，继续给予对症治疗。入院第3天患者尿量明显增多，第5天腹痛、腹胀症状消失，第8天肾功能恢复正常。

A 64-year-old male patient received clozapine 125 mg twice daily for 6 years because of paranoid schizophrenia. The dose of clozapine was increased to 250 mg twice daily by doctor due to his symptoms occurred repeatedly. About one month after increase of drug dosage,the patient developed abdominal pain,distention,nausea,vomiting,and oliguria. Then the drug was stopped by the patient. Two days after the drug withdrawal, the patient visited emergency department in our hospital. Physical examination showed that the patient had abdominal swelling,abdomen tenderness,hypoactive bowel sounds. Laboratory tests showed serum creatinine（ scr）106 μmol/L,blood urea nitrogen（ BUN）11. 2 mmol/L. Abdominal X-ray showed dilatation of the small intestine with multiple ladder-like fluid level. Paralytic ileus was considered. Fasting,fluid supplement,anti-inflammatory,and gastrointestinal decompression were given. The next day,the renal function deteriorated,scr and BUN levels were 606 μmol/L and 27. 2 mmol/L, respectively;and his clozapine plasma concentration was 630 μg/L. Then it was considered that paralytic ileus combined with acute renal insufficiency was induced by clozapine. The patient was admitted to hospital and symptomatic treatments were given continuously. On day 3 after admission,the patient＇s urine volume increased markedly. On day 5 after admission,abdominal pain and distention disappeared and day 8,his renal function returned to normal.