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静脉用脂肪乳剂在严重中毒中没有作用:反对。

Intravenous Lipid Emulsion does NOT have a role in severe poisoning: CON.

机构信息

Monash Toxicology Unit, Monash Emergency Medicine Service, Monash Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia.

Department of Medicine, Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.

出版信息

Br J Clin Pharmacol. 2023 Jun;89(6):1719-1723. doi: 10.1111/bcp.15717. Epub 2023 Apr 4.

Abstract

Intravenous lipid emulsion (ILE) has been suggested as a potential universal antidote for cardiovascular and central nervous system toxicity resulting from a multitude of pharmaceutical and nonpharmaceutical poisonings. While there is some evidence to suggest that ILE may have a positive effect in cardiovascular system toxicity after accidental intravenous lipophilic local anaesthetic overdose, this cannot be extrapolated to cases of severe poisoning resulting from oral drug overdose. Treatment recommendations are based upon variable outcome animal studies and low-level clinical evidence with a significant degree of positive reporting bias. Currently, there is a paucity of controlled clinical data to support ILE use to treat severe drug poisoning after oral overdose. ILE use should be limited to well-designed, ethically approved, controlled clinical trials aimed at determining the true effectiveness of this therapy. This should replace the current scattergun clinical use in a multiplicity of poisoning scenarios and subsequent anecdotal reporting approach.

摘要

静脉内脂质乳剂(ILE)已被提议作为一种潜在的通用解毒剂,用于治疗多种药物和非药物中毒引起的心血管和中枢神经系统毒性。虽然有一些证据表明,ILE 可能对意外静脉内亲脂性局部麻醉剂过量引起的心血管系统毒性有积极影响,但这不能外推到口服药物过量引起的严重中毒病例。治疗建议基于可变的动物研究结果和低水平的临床证据,存在显著的阳性报告偏倚。目前,缺乏支持 ILE 用于治疗口服过量后严重药物中毒的对照临床试验数据。ILE 的使用应限于设计良好、伦理批准、旨在确定这种治疗方法真实效果的对照临床试验。这应取代当前在多种中毒情况下的广泛临床使用和随后的轶事报告方法。

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