北京怀柔“4.23”急性可乐定中毒事件临床救治体会

本研究旨在观察群体性急性可乐定中毒的流行病学特点、临床表现及救治方法,尤其是评价血液灌流（hemoperfusion,HP）治疗急性可乐定中毒的有效性和安全性.通过对北京怀柔4.23急性可乐定中毒事件行流行病学调查,分析所有80例患者的所有流行病学资料,研究病情较重的34例患者的临床表现、治疗方案、预后情况.采用HA230树脂血液灌流器数次HP治疗前后血可乐定、尿可乐定浓度的变化,计算血可乐定浓度下降率,及与常规内科治疗相比HP的排毒效率.观察治疗前患者血压、心率及其他实验室指标如血小板、心肌酶谱、肝酶谱的变化并评价疗效及副作用.研究发现急性可乐定中毒具有隐蔽性强,发病潜伏期短,症状重等特点,HP治疗可显著降低血可乐定水平,短暂升高尿可乐定水平.患者临床症状亦显著改善,血可乐定的下降率为（81±12）%,所有患者经间断HP治疗1～3次后血、尿可乐定水平接近正常.随着患者血可乐定浓度渐趋正常,其临床症状及实验室指标亦能明显改善,短期HP治疗无明显副作用,随访观察半月余,未观察到后遗症.群体性可乐定中毒常常具有危害人群广,症状重风险大,诊治难度大的特点,重者致人死亡,或者造成社会极大恐慌.研究群体性可乐定中毒有浓厚的军事医学意义,HP是治疗可乐定中毒安全有效的治疗手段.

Clinical Analysis of “4.23” Clonidine Poisoning Event in Huairou District of Beijing

This paper aims to make an epidemiological investigation of a group toxication of acute clonidine, identify the clinical characteristics and propose the treatment measures, and study the safety and effect of Hemoperfusion (HP) through clinical analysis of the cases. All the epidemiological data were collected from 80 cases in “4.23” clonidine poisoning event in Huairou District of Beijing. The clinical records of all the 34 severe acute clonidine poisoning cases after treatment of HP with HA230 hemoperfusion cartridge were collected, after comprehensive analysis of the symptoms, physical signs, laboratory index, HP treatment and clinical responses, then a reliable conclusion was obtained. HP treatment could effectively reduce the level of serum clonidine by (81±12)% of acute clonidine poisoning treated after the first HP. After 1-3 times of HP treatment, the clonidine level of serum and urine could be reduced to nearly the normal level. The patients in all cases totally recovered without lingering effects and side effects. Group cases of acute clonidine poisoning often have high-level concealment, severe symptoms, high risks, and difficulty of treatment. It is suggested that HP is an effective method to reduce the clonidine level in blood and urine.