精神药物急性中毒的特点分析及不同时间段血液净化治疗的效果观察

Analysis of the Characteristics of Acute Poisoning of Psychotropic Drugs and Observation of the Effect of Blood Purification Treatment at Different Time Periods

目的:分析精神病药物急性中毒患者的不良反应(adverse drug reactions,ADR)特点,并观察血液净化方法治疗不同时间段中毒患者的疗效。方法:选取2019年1月1日—2023年3月31日我院精神科急诊收治的精神分裂症伴精神病药物急性中毒的40例患者,根据发现中毒时间的早晚分为早发现组(n=24,中毒时间≤6 h)与晚发现组(n=16,中毒时间>6 h)。观察入组患者的临床资料特点、各类精神药物的ADR。通过血液净化(血液透析+血液灌流)治疗后,比较两组患者意识状态的恢复情况、治愈时间、总体治疗前后生命体征变化及相关血液学指标。结果:精神药物急性中毒患者主要以青中年为主;发生ADR事件最多的药物是利培酮、氯丙嗪和奥氮平。发生ADR最多的是低血压、锥体外系反应、心电图QT间期缩短等;早发现组意识状态好转速度优于晚发现组(P<0.05),最多3次血液净化治疗后,两组的意识状态均恢复正常;早发现组患者治愈时间短于晚发现组(P<0.05)。早发现组血压、白细胞计数、转氨酶、肌酸激酶(同工酶)、血肌酐等水平低于晚发现组(P<0.05),而早发现组心率、血氧饱和度、胆碱酯酶等水平高于晚发现组(P<0.05)。结论:精神病药物急性中毒患者的ADR类型较多,早发现早治疗可明显减轻ADR事件,且对其意识状态的恢复、治疗时间的缩短均具有重要的临床意义。

Objective:To analyze the characteristics of adverse drug reactions(ADR)in patients with acute poisoning of psychotropic drugs,and to observe the efficacy of blood purification in the treatment of patients with poisoning at different time periods.Methods:From January 1,2019 to March 31,2023,40 patients with schizophrenia and acute poisoning of psychotropic drugs admitted to the psychiatric emergency department of our hospital were selected.According to the time of poisoning,they were divided into early detection group(n=24,poisoning time≤6 h)and late detection group(n=16,poisoning time>6 h).The clinical data characteristics of the enrolled patients and the ADR of various psychotropic drugs were observed.After blood purification(hemodialysis+hemoperfusion)treatment,the recovery of consciousness,cure time,changes of vital signs and related hematological indexes before and after treatment were compared between the two groups.Results:The patients with acute poisoning of psychotropic drugs were mainly young and middle-aged.The drugs with the most ADR events were risperidone,chlorpromazine and olanzapine.The most common ADRs were hypotension,extrapyramidal reactions,shortened QT interval of electrocardiogram,etc.The improvement rate of consciousness in the early detection group was better than that in the late detection group(P<0.05).After up to 3 times of blood purification treatment,the consciousness of the two groups returned to normal.The cure time of the early detection group was shorter than that of the late detection group(P<0.05).The levels of blood pressure,white blood cell count,transaminase,creatine kinase(isoenzyme)and serum creatinine in the early detection group were lower than those in the late detection group(P<0.05),while the levels of heart rate,blood oxygen saturation and cholinesterase in the early detection group were higher than those in the late detection group(P<0.05).Conclusion:There are many types of ADR in patients with acute poisoning of psychiatric drugs.Early detection and early treatment can significantly reduce ADR events,and have important clinical significance for the recovery of consciousness and the shortening of treatment time.