首页 中华急诊医学杂志 2025年34卷03期 钙通道阻滞剂中毒急诊诊治专家共识
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钙通道阻滞剂中毒急诊诊治专家共识
中华医学会急诊医学分会
中国医药教育协会急诊医学专业委员会
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DOI: 10.3760/cma.j.issn.1671-0282.2025.03.007
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摘要
钙通道阻滞剂(calcium channel blockers, CCBs)又称钙拮抗剂,主要通过阻断心肌和血管平滑肌细胞膜上的钙离子通道,抑制细胞外钙离子内流,使细胞内钙离子水平降低而引起心血管等组织器官功能改变,是临床上最常用的一类心血管药物。CCBs分为二氢吡啶和非二氢吡啶两类,其中,二氢吡啶类的典型代表药物有硝苯地平、氨氯地平、尼莫地平、尼卡地平等,非二氢吡啶类典型代表药物有地尔硫
、维拉帕米。
引用本文
中华医学会急诊医学分会,中国医药教育协会急诊医学专业委员会. 钙通道阻滞剂中毒急诊诊治专家共识[J]. 中华急诊医学杂志,2025,34(03):318-325.
DOI:10.3760/cma.j.issn.1671-0282.2025.03.007PERMISSIONS
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钙通道阻滞剂(calcium channel blockers, CCBs)又称钙拮抗剂,主要通过阻断心肌和血管平滑肌细胞膜上的钙离子通道,抑制细胞外钙离子内流,使细胞内钙离子水平降低而引起心血管等组织器官功能改变,是临床上最常用的一类心血管药物。CCBs分为二氢吡啶和非二氢吡啶两类,其中,二氢吡啶类的典型代表药物有硝苯地平、氨氯地平、尼莫地平、尼卡地平等,非二氢吡啶类典型代表药物有地尔硫
、维拉帕米。
美国中毒中心2022年的数据显示,心血管药物暴露是第六位的毒物暴露因素,而在因中毒导致死亡病例占比中,CCBs是第六大类别药物
[
1
]。在CCBs中毒中,最常见的药物是氨氯地平,它是中毒导致死亡病例中占比最多的CCBs
[
1
]。2022年,氨氯地平占国际多中心毒理学研究和监测网络报告的所有CCBs暴露的三分之二以上
[
2
]。来自澳大利亚的两个毒理学服务机构2014—2023年的数据表示,在CCBs中毒中,二氢吡啶类最常见,其中氨氯地平占一半,值得注意的是,地尔硫
和维拉帕米中毒的临床后果更严重
[
3
]。国内缺乏有关CCBs中毒的统计数据,1项来自单中心的2014—2021年的数据分析显示CCBs中毒病死率是28.8%
[
4
]。目前的诊断和治疗建议主要来源于回顾性分析、病例报告和专家意见。我国缺乏此类疾病诊治方面的统一、规范方案,为此制定本CCBs中毒急诊诊治专家共识,以指导和规范急性CCBs中毒的救治管理。
共识制定方法与制订过程包括:提出关键问题,基于临床问题,以钙通道阻滞剂、中毒、过量为中文检索词,以calcium channel blocker、poisoning及overdose为英文检索词搜索中国知网数据库、万方数据库、维普数据库、PubMed、EMBASE、Web of Science,检索时间截止至2024年10月。系统收集相关文献,撰写初稿,提交共识编写组专家函审提出修改意见。修订后召开专家讨论会确定终稿,再次提交共识编写组专家审核定稿。本共识注册号为PREPARE-2025CN016。
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备注信息
A
马青变,北京大学第三医院急诊科/中毒救治中心,Email:
mocdef.6ab21naibgniqam;
B
李树强,北京大学第三医院职业病科/中毒救治中心,Email:
mocdef.3ab62ilgnaiquhs;
C
赵荣生,北京大学第三医院药学部/中毒救治中心,Email:
nc.defudabe.umjbgnehsgnoroahz;
D
崔丽艳,北京大学第三医院检验科/中毒救治中心,Email:
mocdef.3ab61nayilc
E
PREPARE-2025CN016
F
所有作者声明无利益冲突
G
北京大学第三医院创新转化基金资助
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