Buur T, Larsson R, Norlander B
Department of Nephrology, University Hospital of Linköping, Sweden.
Acta Med Scand. 1988;223(3):269-74. doi: 10.1111/j.0954-6820.1988.tb15797.x.
In a severe case of chloral hydrate intoxication treated with combined hemodialysis and hemoperfusion the pharmacokinetics of the metabolites trichloroethanol (TCE), trichloroethanol glucuronide (TCE-Glu) and trichloroacetic acid (TCA) were studied. Indications of delayed absorption and some slowing of metabolism were found. At a blood flow rate of 200 ml/min clearances by hemodialysis and hemoperfusion, respectively, in ml/min were estimated to be 188 and 156 for TCE, 184 and 181 for TCE-Glu, 142 and 91 for TCA. Clearance by hemoperfusion declined with time. The half-lives of TCE and TCA were 3.2 and 4.3 hours during combined hemodialysis and hemoperfusion. After termination of treatment the half-life of TCE was 12.8 hours, whereas TCA was metabolized so slowly, that no reliable calculation could be performed. We conclude that hemodialysis and hemoperfusion are equally and highly efficient in the treatment of chloral hydrate poisoning, but hemoperfusion may increase the risk of gastric bleeding more than hemodialysis. Hemodialysis may therefore be preferable and should be tried in spite of low blood pressure.
在一例采用血液透析和血液灌流联合治疗的严重水合氯醛中毒病例中，对代谢产物三氯乙醇（TCE）、三氯乙醇葡糖苷酸（TCE-Glu）和三氯乙酸（TCA）的药代动力学进行了研究。发现有吸收延迟和代谢略有减慢的迹象。在血流速度为200 ml/min时，血液透析和血液灌流对TCE的清除率（分别以ml/min计）估计为188和156，对TCE-Glu为184和181，对TCA为142和91。血液灌流的清除率随时间下降。在血液透析和血液灌流联合治疗期间，TCE和TCA的半衰期分别为3.2小时和4.3小时。治疗结束后，TCE的半衰期为12.8小时，而TCA代谢非常缓慢，无法进行可靠的计算。我们得出结论，血液透析和血液灌流在水合氯醛中毒治疗中同样高效，但血液灌流可能比血液透析增加胃出血的风险。因此，尽管血压低，血液透析可能更可取，应予以尝试。
