5例致命性地芬尼多中毒病例分析

An analysis on 5 patients with fatal Diphenidol toxication

目的通过分析5例致命性地芬尼多(眩晕停)中毒病例,为临床急救提供实践数据和经验.方法回顾性分析2019年6月至2020年10月北京朝阳中西医结合急诊抢救中心急诊科收治的5例地芬尼多中毒患者的临床资料,记录患者的一般资料、临床症状及体征、血气分析、心电图检查结果、治疗经过及转归等.结果5例致命性地芬尼多中毒患者中,男性2例,女性3例;年龄20~30岁,平均22.4岁;服药剂量为750~6250 mg,平均3580 mg.1例患者的血液毒物检测结果显示其地芬尼多血药浓度为2.4 mg/L,服药剂量为750 mg.在5例地芬尼多中毒的患者中,2例入院时已无生命体征且复苏无效,表现为复合性酸中毒(pH值分别为6.48和6.71)、高钾血症(血K^(+)分别为6.5 mmol/L和6.5 mmol/L)和高乳酸血症〔血乳酸(Lac)分别为25.0 mmol/L和29.0 mmol/L〕.3例患者经积极抢救后存活,患者共同的临床表现为昏迷、代谢性酸中毒(pH值分别为7.11、7.19、6.75)、低钾血症(血K^(+)分别为3.0、3.0、3.4 mmol/L)和高乳酸血症(Lac分别为12.6、11.0,25.0 mmol/L);其中2例记录到室性心律失常和心脏停搏;3例患者在救治24 h后生命体征趋于稳定.最终3例患者痊愈出院.结论地芬尼多中毒能引起严重不良反应甚至死亡,且多在中毒后24 h内发生,主要临床表现为昏迷、室性心律失常和内环境紊乱,早期识别和恰当处理是救治成功的关键.

Objective To analyze 5 patients with fatal Diphenidol toxication to provide clinical data and practical experiences for clinical emergency rescue of such patients.Methods A retrospective analysis was performed for the clinical data of 5 cases with Diphenidol toxication rescued in the emergency department of Beijing Chaoyang Integrated Medicine Emergency Medical Center from June 2019 to October 2020.The patients'general data,clinical symptoms and signs,blood-gas analysis,electrocardiogram results,therapeutic processes and prognosis were recorded.Results Among the 5 patients mth fatal Diphenidol toxication,there were 2 males and 3 females,aging from 20-30 years old and the mean age was 22.4 years.The drug taken overdoses varied from 750 mg to 6250 mg with an average of 3580 mg.The detection of blood concentration of Diphenidol showed 2.4 mg/L in one case and the administrated overdose was 750 mg.Among the 5 patients with fatal Diphenidol toxication,2 cases had no vital signs on admission and failed in resuscitation,manifesting compound acidosis with the pH of 6.48 and 6.71,hyperkalemia(blood K^(+) of 6.5 mmol/L and 6.5 mmol/L)and hyperlactacidemia[lactic acid(Lac)of 25 mmol/L and 29 mmol/L]respectively.The other 3 cases were recovered after rescue.The common clinical manifestations of the 3 survivors were coma,metabolic acidosis with pH of 7.11,7.19 and 6.75,hypokalemia(blood K^(+) of 3.0,3.0 and 3.4 mmol/L)and hyperlactacidemia(Lac of 12.6,11.0 and 25.0 mmol/L),respectively.Two survivors with ventricular arrhythmia and cardiac arrest during resuscitation were recorded.All of the 3 survivors were revived and their vital signs tended to be stabilized after 24 hours of management.Finally,the 3 patients were cured and disc harged.Conclusions Diphenidol toxication is liable to cause severe adverse reactions and even death,and mosdy occurs within 24 hours after toxication.The main clinical manifestations are coma,ventricular arrhythmia and internal environment disorders.Early identification and proper management are crucial to the patients'successful rescue and survival.