Bek Kenan, Ozkaya Ozan, Mutlu Birgül, Dağdemir Ayhan, Sungur Metin, Açikgöz Yonca, Işlek Ismail, Baysal Kemal
Ondokuz Mayis University Faculty of Medicine, Department of Pediatric Nephrology, Samsun, Turkey.
Nephrology (Carlton). 2008 Jun;13(3):193-7. doi: 10.1111/j.1440-1797.2008.00922.x.
Tricyclic antidepressant (TCA) toxicity is common among children and adults due to widespread use. Amitriptyline (AT) is one of the most commonly prescribed TCAs. Current guidelines do not recommend charcoal haemoperfusion (HP) for AT overdose due to high protein binding and large volume of distribution. However evidence regarding the efficacy of charcoal HP in addition to supportive measures is accumulating in the published reports.
Here we report our experience in 20 children (15 girls, 5 boys) with acute AT overdose aged between 1.5 and 15 years, successfully managed with HP in our institution between January 2000 and February 2007.
The HP indications were mainly severe initial cardiac and respiratory involvement. After HP, all patients recovered dramatically with a mean hospital stay of 4 days (range: 2-12). Only one patient developed neurological sequelae due to prolonged hypoxia secondary to respiratory arrest.
To our knowledge this is the largest case series reporting the efficacy of charcoal HP in acute AT overdose in children. Based on our findings, charcoal HP seems to be an effective treatment modality, especially in prompt correction of severe life-threatening cardiac and respiratory findings in children with serious AT overdose and resulting in a reduction of morbidity and mortality.
由于三环类抗抑郁药（TCA）广泛使用，其中毒在儿童和成人中很常见。阿米替林（AT）是最常处方的TCA之一。由于高蛋白结合率和大分布容积，当前指南不推荐对AT过量使用进行活性炭血液灌流（HP）。然而，除支持性措施外，关于活性炭HP疗效的证据在已发表的报告中不断积累。
在此，我们报告20例1.5至15岁急性AT过量儿童（15名女孩、5名男孩）的治疗经验，这些儿童于2000年1月至2007年2月间在我们机构通过HP成功治疗出院。
HP的指征主要是最初严重的心脏和呼吸受累。HP治疗后，所有患者均显著康复，平均住院时间为4天（范围：2至12天）。仅1例患者因呼吸骤停继发长时间缺氧而出现神经后遗症。
据我们所知，这是报告活性炭HP对儿童急性AT过量疗效的最大病例系列。基于我们的研究结果，活性炭HP似乎是一种有效的治疗方式，特别是对于严重AT过量儿童中迅速纠正严重危及生命的心、肺表现，从而降低发病率和死亡率。
