摘要
目的 通过对1例芬太尼、罗库溴铵引起瞳孔不等大的病例分析与文献复习,探讨原因与机制。方法 参与1例ICU患者ECMO期间发生瞳孔不等大的诊治经过,检索其他药源性瞳孔不等大案例,分析可能原因。结果 临床药师认为,出现瞳孔不等大很可能为芬太尼、罗库溴铵所致并建议医生停用药物,患者瞳孔恢复正常。其原因可能与芬太尼过量、罗库溴铵透过血脑屏障有关。文献检索药源性瞳孔不等大相关病例,涉及药物包括抗胆碱药、抗抑郁药、麻醉药、抗休克的血管活性药、化学合成的抗菌药、肾上腺皮质激素和促肾上腺皮质激素。机制与胆碱能神经传导等相关。结论 临床药师应了解药源性瞳孔不等大相关药物及机制,与医生沟通协作,提升临床用药安全。
Objective To explore the reasons and mechanisms of drug-induced anisocoria through the analysis of a case of fentanyl/rocuronium-induced anisocoria and literature review.Methods By participating in the treatment of an ICU patient with anisocoria during ECMO and researching relevant drug-induced anisocoria cases,the possible causes were analyzed.Results The clinical pharmacist thought that the anisocoria of the patient was probably caused by fentanyl and rocuronium and suggested stopping fentanyl and rocuronium.The patients′pupil returned to normal.Its cause might be related to overdose of fentanyl and penetration of rocuronium through blood-brain barrier.According to literature review,anticholinergics,antidepressants,anesthetics,vasoactive drugs for anti-shock,chemically synthesized antibacterial drugs,adrenal cortex hormones and corticotropin were involved in drug-induced anisocoria.The mechanisms is related to cholinergic mediation and other channels.Conclusion Clinical pharmacist should know drugs which can cause anisocoria and its mechanisms,communicate and collaborate with physician to improve medication safety.
作者
刘佳明
孟慧杰
郭冬杰
LIU Jia-ming;MENG Hui-jie;GUO Dong-jie(Department of Pharmacy,Xuanwu Hospital of Capital Medical University,Beijing 100053,China;Department of Pharmacy,Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University,Beijing 102218,China;Department of Pharmacy,China-Japan Friendship Hospital,Beijing 100031,China)
出处
《实用药物与临床》
CAS
2022年第8期704-709,共6页
Practical Pharmacy and Clinical Remedies
