钙通道阻滞剂中毒流行病学的发展及其对管理的影响。

IF 3.5 3区 医学 Q1 CRITICAL CARE MEDICINE Current Opinion in Critical Care Pub Date : 2024-12-01 Epub Date: 2024-09-25 DOI:10.1097/MCC.0000000000001218
Michael D Simpson, Jon B Cole
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引用次数: 0

摘要

综述目的:本研究旨在概述钙通道阻滞剂(CCB)中毒的最新进展。二氢吡啶类钙通道阻滞剂氨氯地平是美国的常用处方药,氨氯地平中毒的发生率越来越高,这给临床医生带来了新的挑战,因为目前的钙通道阻滞剂中毒处理范例来自于非二氢吡啶类药物的文献:氨氯地平是目前最常见的CCB中毒。大剂量胰岛素是一种强效肌力剂和血管扩张剂,因此应谨慎使用,通常应与血管加压药同时使用,因为理论上它可能会加重氨氯地平中毒患者的血管扩张。当怀疑出现某种程度的心源性休克时,最好使用大剂量胰岛素。静脉体外膜肺氧合在氯苯类药物中毒中的应用似乎正在增加,但可能需要高流速来对抗氨氯地平诱发的血管麻痹。静脉注射脂质乳剂不能作为常规推荐疗法,但可能会在围休克情况下发挥作用。血管紧张素 II、亚甲蓝和羟钴胺等辅助治疗在理论上可提供益处,但仍需进一步研究。总结:氨氯地平可导致大多数 CCB 中毒病例,并可通过多种机制诱发心源性休克和分布性休克。临床医生应根据疑似休克的病因进行治疗,了解难治性休克的辅助治疗方法,并咨询中毒专家。
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Developments in the epidemiology of calcium channel blocker poisoning and implications for management.

Purpose of review: The aim of this study was to outline recent developments in calcium channel blocker (CCB) poisoning. The dihydropyridine CCB amlodipine is commonly prescribed in the United States, and amlodipine poisoning is increasing in frequency, presenting new challenges for clinicians because current paradigms of CCB poisoning management arose from literature on non-dihydropyridine agents.

Recent findings: Amlodipine is now the most common CCB involved in poisoning. High-dose insulin is a potent inotrope and vasodilator; as such, it should be used cautiously, and typically in conjunction with vasopressors, as it theoretically may worsen vasodilation in amlodipine poisoning. High-dose insulin is best used when some degree of cardiogenic shock is suspected. Venoarterial extracorporeal membrane oxygenation utilization in CCB poisoning appears to be increasing, but high flow rates may be needed to combat amlodipine-induced vasoplegia. Intravenous lipid emulsion cannot be routinely recommended but may have a role in peri-arrest situations. Adjunct treatments such as angiotensin II, methylene blue, and hydroxocobalamin offer theoretical benefit but warrant further study.

Summary: Amlodipine causes most cases of CCB poisoning and can induce both cardiogenic and distributive shock through multiple mechanisms. Clinicians should tailor treatment to suspected shock etiology, be aware of adjunct treatments for refractory shock, and consult an expert in poisoning.

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来源期刊
Current Opinion in Critical Care
Current Opinion in Critical Care 医学-危重病医学
CiteScore
5.90
自引率
3.00%
发文量
172
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​​Current Opinion in Critical Care delivers a broad-based perspective on the most recent and most exciting developments in critical care from across the world. Published bimonthly and featuring thirteen key topics – including the respiratory system, neuroscience, trauma and infectious diseases – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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