作者:李秀清 熊辉 陈旭岩 汪波 李桂莲 丁文
关键词： 氟马西林；苯二氮；药物中毒；昏迷
摘 要：为探讨氟马西林对诊断及治疗药物中毒所致昏迷患者的有效性及安全性。31例疑苯二氮类(BZs)药物中毒昏迷患者以氟马西林0.2mg静脉注射，以后0.1 mg·min-1至总剂量达1 mg或患者有反应。注射前后测定镇静程度，改善(2级为有反应。结果有反应者23例(A组):均为苯二氮类中毒，除6例因吸入性肺炎需继续治疗外，余均24 h内出院；无反应者8例(B组):仅有2例与苯二氮类中毒有关。全部病例均无明显药物不良反应。提示氟马西林可安全有效地用于诊断及治疗药物中毒所致昏迷。
Use of Flumazenil in the Diagnosis and Treatment of Coma Patients with Suspected Drug Intoxication
Abstract：To evaluate the efficacy and safety of flumazenil in the diagnosis and treatment of coma patients with suspected drug intoxication. A total of 31 unconscious patients were included. Intravenous bolus injections of 0.2mg flumazenil were given followed by 0.1mg doses every minute until a total dose of 1mg was reached or produced a 2 grades improvement in sedation level grades.The patients were divided into two groups based on their response to flumazenil: groupA, responders (n=23); groupB, nonresponders (n=8). A good response in group A allowed us to retrieve drug information from these patients once mental status had returned to normal: they all admitted taking benzodiazepines. All patients were discharged within 24hrs except 6 who needed further treatment for pneumonia. In group B only two blood samples of the 8 patients who didn——respond to flumazenil treatment contained benzodiazepines; the remaining six were negative. No adverse reactions were observed in any patients who received flumazenil. These results indicate that flumazenil is safe and effective in the diagnosis and treatment of drug intoxication induced coma.
Key words：flumazenil; benzodiazepine ; poisoning
氟马西林或氟马西尼(flumazenil)又称安易醒(anexate)即1，4-咪唑苯二氮,为水溶性苯二氮类药，是第一个用于临床的专一的竞争性苯二氮(BZ)受体拮抗剂。通过竞争性置换中枢神经系统的苯二氮类受体而拮抗苯二氮类的镇静、抗焦虑、肌肉松弛及抗惊厥作用[1]。
苯二氮类药物是急诊最常见的药物中毒原因之一，其代表药物有安定、舒乐安定、硝基安定等，虽大部分患者预后良好，但也可引起严重甚至致命的合并症，需临床做出快速的诊断和积极有效的治疗。本文旨在探讨氟马西林在诊断及治疗苯二氮类药物中毒所致昏迷患者的有效性及安全性。
资料与方法
1. 病例选择
1997年8月～1998年12月因急性意识障碍入我院急诊科疑药物中毒而具体药物不详、镇静程度评分(3分的患者均可入选,如根据家属或其他人所提供的病史肯定为非苯二氮类中毒者不入选。
1.1镇静程度评分标准
清醒，反应敏捷（0分）；清醒，反应迟钝（1分）；困倦（2分）；昏睡，能唤醒（3分）；昏睡，不能唤醒（4分）。
1.2Glasgow昏迷程度评分标准
①对语言的反应，无（1分）；有反应但不理解（2分）；理解不恰当（3分）；有些糊涂（4分）；反应正常（5分）。②睁眼，无（1分）；疼痛刺激睁眼（2分）；可根据指令睁眼（3分）；自发睁眼（4分）。③运动反应，无（1分）；能外展（2分）；能内屈（3分）；能移动（4分）；能进行定位运动（5分）；根据指令随意运动（6分）。