大剂量氨氯地平和坎地沙坦中毒，需要静脉-动脉体外膜肺氧合。
Intoxication with massive doses of amlodipine and candesartan requiring venoarterial extracorporeal membrane oxygenation.
作者信息
Yusuke Minagawa, Hidetoshi Yamana, Yusuke Tsutsumi, Koji Ishigami, Masahito Togo, Susumu Yasuda, Takayuki Ogura
机构信息
Department of Emergency and Critical Care Medicine Saiseikai Utsunomiya Hospital Utsunomiya Japan.
Department of Emergency Medicine National Hospital Organization Mito Medical Center Mito Japan.
出版信息
Acute Med Surg. 2023 Aug 1;10(1):e878. doi: 10.1002/ams2.878. eCollection 2023 Jan-Dec.
BACKGROUND
Calcium channel blockers and angiotensin II receptor blockers are commonly prescribed to treat hypertension. Massive overdoses can cause both distributive and cardiogenic shock because of their effects on vascular smooth muscles and severe myocardial depression.
CASE PRESENTATION
We present the case of a 46-year-old man who was brought to our emergency department after ingesting 1210 mg amlodipine and 936 mg candesartan. The patient's hemodynamic status deteriorated despite treatment with vasopressors, calcium gluconate, and hyperinsulinemia-euglycemia therapy with mechanical ventilation. Venoarterial extracorporeal membrane oxygenation was initiated for refractory shock. The patient was weaned off extracorporeal membrane oxygenation on day 5 and discharged on day 18 of hospitalization.
CONCLUSION
When medical therapies are ineffective, aggressive venoarterial extracorporeal membrane oxygenation should be considered for the management of refractory shock in the setting of calcium channel blocker with angiotensin II receptor blocker overdose.
背景
钙通道阻滞剂和血管紧张素II受体阻滞剂常用于治疗高血压。大量用药过量可因其对血管平滑肌的作用和严重的心肌抑制而导致分布性休克和心源性休克。
病例介绍
我们报告一例46岁男性，在摄入1210毫克氨氯地平和936毫克坎地沙坦后被送至我院急诊科。尽管使用了血管加压药、葡萄糖酸钙以及机械通气下的高胰岛素血症-正常血糖疗法进行治疗，患者的血流动力学状态仍恶化。因难治性休克启动了静脉-动脉体外膜肺氧合。患者在第5天撤离体外膜肺氧合，并于住院第18天出院。
结论
当药物治疗无效时，对于钙通道阻滞剂与血管紧张素II受体阻滞剂过量导致的难治性休克，应考虑积极采用静脉-动脉体外膜肺氧合进行治疗。
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