Winkler E, Almog S, Kriger D, Tirosh M S, Halkin H, Ezra D
Clinical Toxicology Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Crit Care Med. 1993 Apr;21(4):538-42. doi: 10.1097/00003246-199304000-00014.
To evaluate the use of single-dose flumazenil in the diagnosis of coma of unknown etiology, and of continuous flumazenil infusion in the treatment of benzodiazepine-induced coma.
Prospective study.
Emergency room and general medicine ward of a teaching hospital.
A total of 42 comatose adults in whom metabolic, neurologic, or traumatic causes of coma were excluded.
a) Intravenous bolus injections of 0.25 mg flumazenil were given at 1-min intervals, either until improvement by two coma grades or a total dose of 2.0 mg was reached. b) Loading doses as in (a) followed by a maintenance infusion administered as long as indicated by repeated coma grade evaluation.
a) Of 34 patients, 28 received only the flumazenil loading dose responded promptly. Twenty-one of 25 available urine samples of the responding patients contained only benzodiazepine metabolites. Four urine samples contained benzodiazepines in combination with other drugs. Six patients did not respond to the flumazenil loading dose. The urine of three patients contained a combination of benzodiazepines and another coma-exerting drug; the remaining three were negative. A total of 24 patients, who initially responded to flumazenil loading, deteriorated to their previous coma state and were admitted to the general medical ward. Six (25%) patients developed complications related to hospitalization and their bedridden state. b) Eight other patients, who deteriorated after an initial loading dose, received a second iv bolus of flumazenil, followed by maintenance infusions over 5 to 24 hrs. Their hospital course was uneventful.
These findings indicate that flumazenil is safe and effective in the diagnosis of benzodiazepine-induced coma. Furthermore, the use of continuous flumazenil maintenance infusion is of considerable therapeutic value in patients who exhibit deterioration after initial response to the single loading dose.
评估单剂量氟马西尼在不明病因昏迷诊断中的应用，以及持续输注氟马西尼在治疗苯二氮䓬类药物所致昏迷中的应用。
前瞻性研究。
一家教学医院的急诊室和普通内科病房。
共42名昏迷成人，排除了代谢、神经或创伤性昏迷原因。
a）每隔1分钟静脉推注0.25mg氟马西尼，直至昏迷程度改善两级或达到2.0mg的总剂量。b）按（a）中的负荷剂量给药，随后根据重复的昏迷程度评估结果进行持续输注。
a）34名患者中，28名仅接受氟马西尼负荷剂量的患者反应迅速。25份有反应患者的尿液样本中，21份仅含有苯二氮䓬类药物代谢物。4份尿液样本含有苯二氮䓬类药物与其他药物的混合物。6名患者对氟马西尼负荷剂量无反应。3名患者的尿液中含有苯二氮䓬类药物与另一种导致昏迷的药物的混合物；其余3名患者尿液检测为阴性。共有24名最初对氟马西尼负荷剂量有反应的患者病情恶化至先前的昏迷状态，并被收入普通内科病房。6名（25%）患者出现了与住院及卧床状态相关的并发症。b）另外8名患者在初始负荷剂量后病情恶化，接受了第二次静脉推注氟马西尼，随后进行了5至24小时的持续输注。他们的住院过程顺利。
这些结果表明，氟马西尼在诊断苯二氮䓬类药物所致昏迷方面安全有效。此外，对于初始单剂量负荷给药后出现病情恶化的患者，持续输注氟马西尼维持治疗具有相当大的治疗价值。
