Asbach H W, Möhring K, Holz F, Schüler H W, Herrmann B, Faigle J W
Klin Wochenschr. 1976 Jan 15;54(2):83-7. doi: 10.1007/BF01468773.
In the last several years an increasing number of severe imipramine intoxications have been observed. Though standard principles for the treatment of acute tricyclic poisoning have been established, nonetheless there still exists doubt on the most effective method of tricyclic removal in cases of massive overdose. Haemodialysis was successfully employed until now but has not found general acceptance as only insignificant amounts of imipramine could be recovered from the dialysate. An experimental clearance study was undertaken using radiolabelled imipramine (14C-I) to obtain insight into the usefullness of haemodialysis in imipramine poisoning. 14C-I clearances which were calculated in a closed circuit dialysis system ranged between 18 ml/min and 48 ml/min depending on the constitution of the dialysate, i.e. aqueous or lipid solution. Surprisingly a rapid and significant uptake of imipramine by the plastic material (polyvinylchloride) of the extracorporeal blood line system was detected. This escape of imipramine from the blood into the tubings explains the poor recovery of tricyclics from the dialysate, which discredited haemodialysis as a therapeutical method in imipramine poisoning. The results of our experiments may offer a new method of rapid tricyclic elimination in severe imipramine intoxications.
在过去几年中，已观察到越来越多严重的丙咪嗪中毒病例。尽管急性三环类中毒的标准治疗原则已经确立，但对于大量过量服用三环类药物时最有效的清除方法仍存在疑问。血液透析迄今已成功应用，但尚未得到广泛认可，因为从透析液中仅能回收少量的丙咪嗪。进行了一项使用放射性标记丙咪嗪（14C-I）的实验清除研究，以深入了解血液透析在丙咪嗪中毒中的有效性。在闭路透析系统中计算出的14C-I清除率在18毫升/分钟至48毫升/分钟之间，这取决于透析液的成分，即水性或脂质溶液。令人惊讶的是，检测到体外血路系统的塑料材料（聚氯乙烯）对丙咪嗪有快速且显著的摄取。丙咪嗪从血液中逸出进入管道，这就解释了从透析液中回收三环类药物的效果不佳，这使得血液透析作为丙咪嗪中毒的一种治疗方法受到质疑。我们的实验结果可能为严重丙咪嗪中毒提供一种快速清除三环类药物的新方法。
