18例环喷托酯滴眼液引起中枢神经系统不良反应的文献分析

Literature analysis of 18 cases of central nervous system adverse reactions induced by cyclopentolate eye drops

目的研究散瞳药物环喷托酯滴眼液导致中枢神经系统这一特殊不良反应的临床特点,以保障临床安全合理用药。方法检索PubMed、Elsevier、Science Direct、Embase、Springer Link、FAERS、VigiBase、万方、中国知网数据库,检索时间为从建库至2022年8月7日,收集环喷托酯滴眼液引起的中枢神经系统不良反应个案报道,并对患者基本信息、用法用量、基础疾病、合并用药、不良反应发生时间、表现、处理及转归10个方面进行分析。结果共检索到18篇个案文献报道,涉及18例患者,男性占比72%,年龄11个月~82岁,其中小于18岁占比67%。患者应用环喷托酯滴眼液后,出现不同程度的中枢神经系统不良反应,主要表现为嗜睡、恶心、流涎、共济失调、语无伦次、幻觉等症状,其中16例(89%)患者在24 h内症状完全缓解,2例(11%)患者症状无明显缓解,转入相关科室行进一步治疗。结论环喷托酯滴眼液局部应用可诱发严重中枢神经系统不良反应,特别对于年龄小于18岁的儿童以及自身患有神经系统相关疾病的患者,应在给药后密切监护,对于可能发生的中枢神经系统不良反应,能够及时恰当处理。

Objective To analyze the characteristics of central nervous system(CNS)adverse reactions caused by cyclopentolate eye drops in order to ensure safe and rational clinical medication.Methods PubMed,Elsevier,Science Direct,Embase,Springer Link,FAERS,VigiBase,Wanfang and CNKI were searched,with the searching time from the establishment time of databases to August 7th,2022.The case report on adverse reactions of CNS induced by cyclopentolate eye drops were collected;the patient′s general information,the dosage of cyclopentolate eye drops,fundamental disease,concomitant medication,the occurrence time of adverse reactions and their manifestations,treatment and outcome were analyzed.Results A total of 18 case reports were retrieved.Among the 18 patients,72%were male,the age ranged from 11 months to 82 years old.Among them,the patients less than 18 years old accounted for 67%.After the application of cyclopentolate eye drops with different concentrations,18 patients had different degrees of CNS adverse reactions,mainly including drowsiness,nausea,salivation,ataxia,incoherence,hallucinations and other symptoms.The symptoms of 16 patients(89%)disappeared within 24 hours;2 cases(11%)had no significant relief and were transferred to relevant departments for further treatment.Conclusion Cyclopentolate eye drops can induce severe CNS adverse reactions,especially for children under 18 and patients with nervous system-related diseases,who should be carefully observed so that when adverse reactions occur,symptomatic and appropriate treatment can be performed in time.