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苯妥英中毒

Authors
Mark Su, MD, MPH
Allon Amitai, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
胡佳文, 副主任医师

引言

苯妥英(例如，大仑丁)是一种抗癫痫药，用于治疗多种癫痫发作。也是一种Vaughan-WilliamsⅠB类抗心律失常药物，不过现在很少用于治疗心律失常。

苯妥英的毒性很少致命，但可引起不同程度的神经系统症状，轻者为眼球震颤，重者共济失调，甚至昏迷。罕见情况下，静脉给予苯妥英可能并发Purple Glove Syndrome。

本文将总结苯妥英中毒的基础药理学、表现和处理。临床上使用苯妥英治疗癫痫以及关于中毒患者的处理的一般问题将在别处讨论。一张有助于紧急处理的总结表提供在此(表 1)。(参见“成人癫痫处理概述”和“成人药物中毒的一般处理方法”)

流行病学

苯妥英中毒很少引起严重不良事件或致死。根据美国中毒控制中心协会(American Association of Poison Control Centers, AAPCC)全国中毒数据系统2011年的年度报告，1971例苯妥英这一单一物质暴露仅导致出现了46例严重不良结局和1例死亡[1]。在多重物质暴露的病例中报道了4例被认为与苯妥英或磷苯妥英有关的死亡病例，但这些病例中确定的首要死因均不是苯妥英。严重不良结局和死亡的低发生率与前些年的情况相似[2]。

苯妥英的前体药物磷苯妥英被认为其不良反应较苯妥英少。然而，在1997-2003年间，美国食品药品监督管理局(Food and Drug Administration, FDA)收到了29例与输注磷苯妥英相关的心脏事件报告[3]。其中10例导致死亡。心律失常事件包括心动过缓、高度房室传导阻滞和窦性停搏。这些患者中很多在先前就有显著的心脏病变，或者疑似因癫痫持续状态而使心脏处于应激状态，因此不清楚在这些心律失常中有多少是由磷苯妥英直接导致。

                       

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Literature review current through: 2017-06 . | This topic last updated: 2015-10-27.
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