Kolcz Jacek, Pietrzyk Jacek, Januszewska Katarzyna, Procelewska Malgorzata, Mroczek Tomasz, Malec Edward
Department of Pediatric Cardiac Surgery, Polish-American Children's Hospital, Jagiellonian University, Kraków, Poland.
J Intensive Care Med. 2007 Nov-Dec;22(6):381-5. doi: 10.1177/0885066607307528.
Combined poisoning with calcium-channel blockers and beta-blockers is usually associated with severe heart failure. This report shows the effectiveness of emergency extracorporeal life support in treating life-threatening simultaneous propranolol and verapamil intoxication. A 15-year-old girl presented in cardiogenic shock after alcohol consumption and a propranolol and verapamil overdose; plasma concentrations: propranolol, 0.53 m/mL; verapamil, 1.06 mg/mL. She was successfully resuscitated with extracorporeal life support. Therapeutic plasma exchange was initiated. Extracorporeal support was discontinued 70 hours later. The patient made a full recovery. Simultaneous verapamil and propranolol overdoses can cause severe hemodynamic compromise and arrest of electrical and mechanical function of the heart. Emergency extracorporeal life support can successfully maintain vital organ blood flow and allows time for drug metabolism, redistribution, and removal. Therapeutic plasma exchange may reduce the time of emergency extracorporeal life support. Emergency extracorporeal life support should be considered early in cases of near-fatal intoxications with cardiodepressive drugs.
钙通道阻滞剂和β受体阻滞剂联合中毒通常与严重心力衰竭相关。本报告显示了紧急体外生命支持在治疗危及生命的普萘洛尔和维拉帕米同时中毒方面的有效性。一名15岁女孩在饮酒后出现心源性休克，并过量服用了普萘洛尔和维拉帕米；血浆浓度：普萘洛尔0.53 m/mL；维拉帕米1.06 mg/mL。她通过体外生命支持成功复苏。开始进行治疗性血浆置换。70小时后停止体外支持。患者完全康复。维拉帕米和普萘洛尔同时过量可导致严重的血流动力学损害以及心脏电和机械功能停止。紧急体外生命支持可成功维持重要器官的血流，并为药物代谢、重新分布和清除留出时间。治疗性血浆置换可能会缩短紧急体外生命支持的时间。对于心脏抑制药物导致的近乎致命的中毒病例，应尽早考虑紧急体外生命支持。
