Brahmi Nozha, Kouraichi Nadia, Thabet Hafedh, Amamou Mouldi
Intensive Care Unit, Centre d'Assistance Médicale Urgente, 1008 Montfleury, Tunis-Tunisia.
Am J Emerg Med. 2006 Jul;24(4):440-3. doi: 10.1016/j.ajem.2005.12.025.
Carbamazepine (CBZ) poisoning has been associated with cases of severe toxicity and death. Multiple-dose activated charcoal was proposed to enhance the clearance of CBZ elimination, but there are no prospective controlled studies that demonstrated a change in clinical outcome after the use of multiple-dose activated charcoal. The aim of this study was to determine the CBZ elimination kinetics and the evolution of clinical features according to the dose of activated charcoal in acute poisoning patients. It is a prospective study for 6 months, from January to June 2004, including all pure acute CBZ-poisoned patients. Twelve patients were randomized to receive a multiple-dose activated charcoal (G1) or a simple dose of 1 g/kg (G2). Their mean age was 27.6+/-12.2 years; the Simplified Acute Physiology Score (SAPS II), 16.37+/-8.46; and the Acute Physiology and Chronic Health Evaluation (APACHE II), 8+/-3.96. They were 8 men and 4 women. The mean concentration of blood CBZ at hospital admission was of 29.42+/-6.68 mg/L. Each group includes 6 patients. The peak value of blood CBZ was comparable in the 2 groups: 33+/-3.46 mg/L (G1) vs 32.6+/-5.63 (G2) (P=.5); the requirement of mechanical ventilation was similar also (3 in each group). The duration of both coma and mechanical ventilation was significantly decreased in the first group compared with the second: 20.33+/-3.05 vs 29.33+/-4.11 hours for coma (P=.02) and 24.1+/-4.2 vs 36.4+/-3.6 hours for mechanical ventilation (P=.001). The length of stay was also significantly decreased in the first group: 30.3+/-3.4 vs 39.7+/-7.3 hours in the second group (P=.000006). Concurrently, we have noted a significant constant reduction of the half-life of CBZ from serum in the first group: 12.56+/-3.5 hours after multiple dose vs 27.88+/-7.36 hours after a simple dose (P=.0004). This decrease was correlated to the dose of charcoal. In summary, we can conclude that multiple-dose activated charcoal is more efficient than simple-dose; it permits a constant decrease of the half-life of blood CBZ without any rebound effect and could improve the prognosis by reducing the duration of coma and the length of stay.
卡马西平（CBZ）中毒与严重毒性反应及死亡病例相关。曾有人提出多次剂量活性炭可促进CBZ清除，但尚无前瞻性对照研究表明使用多次剂量活性炭后临床结局有改变。本研究旨在确定急性中毒患者中CBZ的消除动力学以及根据活性炭剂量临床特征的演变情况。这是一项为期6个月的前瞻性研究，从2004年1月至6月，纳入所有单纯急性CBZ中毒患者。12名患者被随机分为接受多次剂量活性炭组（G1）或单次1 g/kg剂量组（G2）。他们的平均年龄为27.6±12.2岁；简化急性生理学评分（SAPS II）为16.37±8.46；急性生理学与慢性健康评估（APACHE II）为8±3.96。其中男性8名，女性4名。入院时血液中CBZ的平均浓度为29.42±6.68 mg/L。每组包括6名患者。两组血液中CBZ的峰值相当：33±3.46 mg/L（G1）对32.6±5.63（G2）（P = 0.5）；机械通气需求也相似（每组3例）。与第二组相比，第一组昏迷和机械通气的持续时间均显著缩短：昏迷时间为20.33±3.05小时对29.33±4.11小时（P = 0.02），机械通气时间为24.1±4.2小时对36.4±3.6小时（P = 0.001）。第一组的住院时间也显著缩短：第二组为39.7±7.3小时，第一组为30.3±3.4小时（P = 0.000006）。同时，我们注意到第一组血清中CBZ的半衰期持续显著缩短：多次剂量后为12.56±3.5小时，单次剂量后为27.88±7.36小时（P = 0.0004）。这种缩短与活性炭剂量相关。总之，我们可以得出结论，多次剂量活性炭比单次剂量更有效；它能使血液中CBZ的半衰期持续缩短且无任何反跳效应，并可通过缩短昏迷持续时间和住院时间改善预后。
