Sedogawa Hiraku, Matsuo Mitsuhiro
Department of Anesthesiology, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata, 941-8502, Japan.
JA Clin Rep. 2020 Feb 29;6(1):17. doi: 10.1186/s40981-020-00323-w.
Cholinergic crisis caused by cholinesterase inhibitors is rare but life-threatening. Clinical manifestations are thought to be similar to those caused by organophosphates.
A 77-year-old woman on a standard dose of distigmine presented with impaired consciousness, blood pressure (BP) of 69/40 mmHg, a pulse rate (PR) of 60 beats/min, miosis, bronchorrhea, and serum cholinesterase (ChE) of 8 IU/L. After discontinuation of distigmine, altered mental status and pupil miosis were gradually resolved in 5 days with a concomitant increase of serum ChE. A 91-year-old woman presented with a headache, BP of 202/86 mmHg, PR of 83 beats/min, miosis, 9 rivastigmine patches on her knees, and ChE of 22 IU/L. The day after close observation without rivastigmine use, her symptoms were almost resolved with a concomitant increase of serum ChE.
Our cases and a literature review suggested that, in contrast to distigmine, rivastigmine-induced cholinergic crisis caused hypertension and tachycardia.
胆碱酯酶抑制剂引起的胆碱能危象罕见但危及生命。其临床表现被认为与有机磷中毒所致临床表现相似。
一名77岁女性，服用标准剂量的地斯的明后出现意识障碍、血压69/40 mmHg、心率60次/分钟、瞳孔缩小、支气管分泌过多以及血清胆碱酯酶（ChE）为8 IU/L。停用 地斯的明后，精神状态改变和瞳孔缩小在5天内逐渐缓解，同时血清ChE升高。一名91岁女性，出现头痛、血压202/86 mmHg、心率83次/分钟、瞳孔缩小、膝盖上有9片卡巴拉汀贴片以及ChE为22 IU/L。在未使用卡巴拉汀密切观察后的第二天，她的症状几乎完全缓解，同时血清ChE升高。
我们的病例及文献回顾表明，与地斯的明不同，卡巴拉汀引起的胆碱能危象会导致高血压和心动过速。
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