Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure
Extracorporeal life support in a case of acute carbamazepine poisoning with life-threatening refractory myocardial failure
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DOI：
10.1007/s00134-006-0257-8
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发表时间：
2006-09-01
影响因子：
38.9
通讯作者：
Baud, Frederic J.
中科院分区：
文献类型：
--
作者：
Megarbane, Bruno;Leprince, Pascal;Baud, Frederic J.
目的：目的：报告体外生命支持（ECLS）在急性卡马西平中毒伴持续性难治性心肌衰竭和高度传导紊乱中的疗效。设计和设置：从毒理学和医学重症监护病房在一所大学医院的病例报告。病人：1例26岁男性，自杀性摄入32 g缓释卡马西平后，对1.7 μ g kg（-1）min（-1）肾上腺素和1.9 μ g kg（-1）min（-1）去甲肾上腺素无反应（SvO（2），17.8%和心脏指数，0.81 min（-1）m（-2））。干预措施：ECLS（Jostra-Maquet离心泵（Rotaflow）连接到中空纤维膜式氧合器）。测量和结果：ECLS装置允许强心剂撤机，同时维持终末器官功能，并支持患者直至心肌恢复。入院时血浆卡马西平水平为224 μ mol/l，入院后101 h达到峰值338 μ mol/l，尽管多次给予活性炭，但胃肠道吸收期延长。患者存活，并于第6天成功复苏。观察到下腔静脉广泛和退行性血栓形成。在2年随访时，心脏功能完全恢复。无明显后遗症。结论：我们报告一例急性卡马西平中毒继发传导紊乱的危及生命的心肌衰竭，证明ECLS有助于恢复的疗效。
Objective: To report the efficacy of extracorporeal life support (ECLS) in acute carbamazepine poisoning with sustained refractory myocardial failure and a high degree of conductance disturbances. Design and setting: Case report from the toxicological and medical intensive care unit in a university hospital. Patient: A 26-year-old man with severe myocardial failure unresponsive to 1.7 mu g kg(-1) min(-1) epinephrine and 1.9 mu g kg(-1) min(-1) norepinephrine (SvO(2), 17.8% and cardiac index, 0.81 min(-1) m(-2)) following a suicidal ingestion of 32 g slow-release carbamazepine. Interventions: ECLS (Jostra-Maquet centrifugal pump (Rotaflow) connected to a hollow-fiber membrane oxygenator). Measurements and results: ECLS device allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery. The plasma carbamazepine level was 224 mu mol/l on admission and peaked at 338 mu mol/l 101 h after admission with a prolonged gastrointestinal absorption phase despite multiple doses of activated charcoal. The patient survived and was successfully explanted on day 6. An extensive and regressive thrombosis of the inferior vena cava was noted. Cardiac function totally recovered and at 2-year follow-up. There were no significant sequelae. Conclusions: We report a case of life-threatening myocardial failure with conductance disturbances secondary to an acute carbamazepine poisoning, demonstrating the efficacy of ECLS to assist recovery.