儿童氨氯地平中毒1例及文献复习

A Case of Amlodipine Poisoning in Children and Literature Review

摘要: 目的：通过分析1例氨氯地平中毒患儿症状、体征、辅助检查及治疗，使广大临床医师了解疾病特点。方法：对青岛大学附属医院儿童重症医学科1例氨氯地平中毒患儿进行分析。结果：本文报道了一例氨氯地平中毒引起肺水肿患儿。该患儿系青春期女童，因“发现吞服胶囊刀片、过量降压药7小时”入院。入院第2天出现肺水肿，给予去甲肾上腺素、钙剂、呼吸机辅助通气、血浆置换及补液等治疗，并予灌肠治疗促进刀片排出。入院第15天，患儿症状消失，复查腹部正位片未见金属影，胸部CT较前明显好转，予出院。结论：氨氯地平是一种二氢吡啶类长效钙通道阻滞剂。过量氨氯地平可引起低血压、心律失常、高血糖、代谢性酸中毒、非心源性肺水肿等，甚至心脏骤停，病死率高。本文就氨氯地平中毒的临床表现、相关病理机制及治疗进行了探讨。

Abstract: Objective: The aim of this paper is to enable clinical physicians to gain a more complete under-standing of the characteristics of amlodipine poisoning by analyzing the symptoms, signs, auxiliary examinations, and treatment of a child with the illness. Methods: Analyzing an amlodipine poison-ing case involving a child hospitalized in the PICU of The Affiliated Hospital of Qingdao University. Results: This paper describes a youngster who developed pulmonary edema from amlodipine poi-soning. The patient is a teenage girl admitted to the hospital after “overdose of antihypertensive medications and swallowing capsule blades for roughly 7 hours”. The second day of the hospital stay saw the development of pulmonary edema. Norepinephrine, calcium, ventilator-assisted breathing, plasma exchange and an enema to encourage blade discharge were used to treat the girl. The pa-tient’s symptoms disappeared on the 15th day after being admitted, a reexamination of the ab-dominal X-ray revealed no metal shadow, and the chest CT showed significant improvements over the previous results. The girl was then discharged from the hospital. Conclusions: Amlodipine is a dihydropyridine Calcium channel blocker. A significant mortality is associated with the adverse ef-fects of amlodipine overdose, which include hypotension, arrhythmia, hyperglycemia, metabolic acidosis, non-cardiogenic pulmonary edema, and even cardiac arrest. This paper discusses the clin-ical manifestations, related pathological mechanisms, and treatment of amlodipine poisoning.