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目的:观察急性缺血性卒中患者低温治疗中抗寒战药物的不良反应。方法:2005年11月1日至2007年8月30日期间,对发病3 d内的15例急性脑梗死患者进行了低温治疗,男10例,女5例,平均年龄(57±1)岁。其中体表低温10例,血管低温5例。所有患者在低温治疗前给予抗寒战药物。体表低温患者静脉推注负荷剂量氯丙嗪和异丙嗪各25 mg,随后各静脉持续泵入1～5 mg/h,并根据寒战程度调整剂量。血管内低温患者中非昏迷者先静脉推注负荷剂量哌替啶1 mg/kg和负荷剂量异丙嗪25 mg,后持续泵入哌替啶25～35 mg/h和异丙嗪1.5～3 mg/h,当患者出现1级寒战时,再次静脉推注哌替啶10～25 mg,并持续泵入哌替啶5 mg/h,直至寒战控制;昏迷患者静脉输注负荷剂量阿曲库铵0.4 mg/kg,并持续泵入5μg/(kg.min),最大剂量为45 mg/h。结果:15例患者中7例发生不良反应,发生率为46.7%。10例体表低温患者中,4例出现不良反应,其中2例为快速心房纤维颤动(154次/min及157次/min),2例血压下降[171/82降至97/50 mm Hg(1 mm Hg=0.133 kPa)及192/109降至113/87 mm Hg];5例血管内低温患者3例出现不良反应,其中1例出现呼吸频率减慢(8次/min),1例呼吸频率减慢同时伴心率减慢(77次/min)和血压下降(88/39 mm Hg),1例血压下降(57/39 mm Hg)。7例患者中除2例因快速心房纤维颤动不能纠正而终止体表低温治疗外,其余患者经对症处理不良反应消失。结论:抗寒战药物不良反应主要为心率变化和血压下降;多数反应较轻,不影响低温治疗。
Objective: To observe the adverse reactions of anti-chills drugs in the treatment of acute ischemic stroke. METHODS: From November 1, 2005 to August 30, 2007, 15 patients with acute cerebral infarction within 3 days of onset were treated with hypothermia, including 10 males and 5 females, with an average age of 57 ± 1 years . One of 10 cases of surface hypothermia, vascular hypothermia in 5 cases. All patients were given anti-chills medication before hypothermia. Patients with hypothermia were intravenously injected with 25 mg of each dose of chlorpromazine and promethazine, followed by continuous infusion of 1 to 5 mg / h of each vein and dose adjustments based on the severity of the chills. Intravenous hypothermia patients with non-coma intravenous bolus dose of pethidine 1 mg / kg and loading dose of promethazine 25 mg, followed by pethidine 25 ~ 35 mg / h and promethazine 1.5-3 mg / h. When the patient presented with grade 1 chills, intravenous injection of pethidine 10-25 mg and continuous pethidine 5 mg / h were administered until chills control; intravenous infusion of amikacin Ammonium 0.4 mg / kg, and continue to pump 5μg / (kg.min), the maximum dose of 45 mg / h. Results: Among 15 patients, 7 cases had adverse reactions, the incidence was 46.7%. Four of the 10 patients with hypothermia showed adverse reactions, including 2 cases of rapid atrial fibrillation (154 beats / min and 157 beats / min) and 2 blood pressure drops (171/82 to 97/50 mm Hg 1 mm Hg = 0.133 kPa) and 192/109 decreased to 113/87 mm Hg]. In 5 patients with intravascular hypothermia, 3 patients showed adverse reactions, including 1 case of slow breathing (8 times / min) and 1 case of respiration The frequency was slowed down accompanied by a decrease in heart rate (77 beats / min) and a decrease in blood pressure (88/39 mm Hg) and a decrease in blood pressure (57/39 mm Hg). Seven patients in addition to two cases because of rapid atrial fibrillation can not be corrected to terminate the body surface hypothermia treatment, the remaining patients by symptomatic treatment of adverse reactions disappeared. Conclusion: The adverse reactions of anti-chills drugs are mainly changes of heart rate and blood pressure; the majority of reactions are mild and do not affect the treatment of hypothermia.