芬太尼透皮贴剂致昏迷

Coma due to fentanyl transdermai patches

1例75岁胃部肿瘤切除术后患者因腹痛在家自行间断应用芬太尼透皮贴剂1贴（4.2 mg）到1.5贴（6.3 mg）半个月。半个月来患者逐渐出现嗜睡、乏力。入院前一晚患者因腹部疼痛将1.5贴贴剂贴于腹部后入睡，次日早晨家属发现患者昏迷，呼之不应。急诊入院后经检查排除脑血管意外，予吸氧、改善循环等对症处理，2 d后患者神志逐渐恢复（期间贴剂使用72 h后去除，未再使用）。因腹痛遵医嘱再次应用芬太尼透皮贴剂1贴，3 h后患者再次出现以上症状，考虑由芬太尼引起。立即去除芬太尼透皮贴剂，给予吸氧、静脉注射纳洛酮等对症处置，2 h后患者神志恢复正常。

A 75-year-old male patient self-medicated with 1 to 1.5 patches of transdermal fentanyl patches （4.2 mg-6.3 mg） for abdominal pain of postoperative gastric cancer about half a month. In recent half a month, he gradually developed somnolence and fatigue. At night before the day the patient was admitted, he received 1.5 patches of transdermal fentanyl patches before sleep for severe abdomen pain. On the second day morning, the patient′s family members found that he developed coma and had no response to voice stimuli. Then he was admitted to emergency department. After cerebrovascular accident was excluded, treatments such as oxygen inhalation and improving blood flow etc. were given. Two days later, the patient regained consciousness gradually （the transdermal fentanyl patch before admission was removed after 72 h of treatment）. The patient received another patch of transdermal fentanyl patch for abdominal pain again following the doctor′s advice and 3 h later, coma recurred. It was considered that coma was induced by transdermal fentanyl patches. The transdermal fentanyl patch was removed immediately and oxygen inhalation, IV infusion of naloxone were given. Two hours later, he regained consciousness.