专家共识
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
作者及单位信息
·
DOI: 10.3760/cma.j.issn.1671-0282.2025.03.007
68
49
0
0
3
0
PDF下载
APP内阅读
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.1671-0282.2025.03.007

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价
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。
试读结束,您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
Gummin DD , Mowry JB , Beuhler MC ,et al. 2022 annual report of the national poison data system ® (NPDS) from America ' s poison centers®: 40th annual report [J]. Clin Toxicol (Phila), 2023,61(10):717-939. DOI: 10.1080/15563650.2023.2268981 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Amaducci AM , Campleman SL , Li S ,et al. The toxicology investigators consortium 2022 annual report[J]. J Med Toxicol, 2023,19(4):313-340. DOI: 10.1007/s13181-023-00962-2 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Isbister GK , Jenkins S , Harris K ,et al. Calcium channel blocker overdose: Not all the same toxicity[J]. Br J Clin Pharmacol, 2025,91(3):740-747. DOI: 10.1111/bcp.16258 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
钟志涛,赵敏. 52例钙通道阻滞剂中毒患者死亡影响因素分析[J]. 中国医科大学学报, 2022,51(12):1131-1135. DOI: 10.12007/j.issn.0258-4646.2022.12.014 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Rietjens SJ , de Lange DW , Donker DW ,et al. Practical recommendations for calcium channel antagonist poisoning[J]. Neth J Med, 2016,74(2):60-67.
返回引文位置Google Scholar
百度学术
万方数据
[6]
Engebretsen KM , Morgan MW , Stellpflug SJ ,et al. Addition of phenylephrine to high-dose insulin in dihydropyridine overdose does not improve outcome[J]. Clin Toxicol (Phila), 2010,48(8):806-812. DOI: 10.3109/15563650.2010.521753 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Levine M , Boyer EW , Pozner CN ,et al. Assessment of hyperglycemia after calcium channel blocker overdoses involving diltiazem or verapamil[J]. Crit Care Med, 2007,35(9):2071-2075. DOI: 10.1097/01.ccm.0000278916.04569.23 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Salhanick SD , Shannon MW . Management of calcium channel antagonist overdose[J]. Drug Saf, 2003,26(2):65-79. DOI: 10.2165/00002018-200326020-00001 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Lheureux PER , Zahir S , Gris M ,et al. Bench-to-bedside review: hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers[J]. Crit Care, 2006,10(3):212. DOI: 10.1186/cc4938 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Lindeman E , Ålebring J , Johansson A ,et al. The unknown known: non-cardiogenic pulmonary edema in amlodipine poisoning, a cohort study[J]. Clin Toxicol (Phila), 2020,58(11):1042-1049. DOI: 10.1080/15563650.2020.1725034 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Ho A , Go A , Barrios C ,et al. Severe noncardiogenic pulmonary edema secondary to massive verapamil overdose and treatment with venovenous extracorporeal membrane oxygenation[J]. Case Rep Crit Care, 2020,2020:8842303. DOI: 10.1155/2020/8842303 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Shepherd G . Treatment of poisoning caused by β-adrenergic and calcium-channel blockers[J]. Am J Health Syst Pharm, 2006,63(19):1828-1835. DOI: 10.2146/ajhp060041 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Wax PM . Intestinal infarction due to nifedipine overdose[J]. J Toxicol Clin Toxicol, 1995,33(6):725-728. DOI: 10.3109/15563659509010638 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Perbet S , Constantin JM , Guérin R ,et al. Non-occlusive colonic ischemia induced by verapamil ER overdose[J]. Intensive Care Med, 2009,35(5):956-957. DOI: 10.1007/s00134-008-1375-2 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Goldfine CE , Troger A , Erickson TB ,et al. Beta-blocker and calcium-channel blocker toxicity: current evidence on evaluation and management[J]. Eur Heart J Acute Cardiovasc Care, 2024,13(2):247-253. DOI: 10.1093/ehjacc/zuad138 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
St-Onge M , Anseeuw K , Cantrell FL ,et al. Experts consensus recommendations for the management of calcium channel blocker poisoning in adults[J]. Crit Care Med, 2017,45(3):e306-e315. DOI: 10.1097/CCM.0000000000002087 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
<x>St</x> <x>ephen</x> VS , Pluymers NA , Gauton SJ . Emergency management of calcium channel blocker overdose[J]. S Afr Med J, 2019,109(9):635-638. DOI: 10.7196/SAMJ.2019.v109i9.13704 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Lapatto-Reiniluoto O , Kivistö KT , Neuvonen PJ . Gastric decontamination performed 5 Min after the ingestion of temazepam, verapamil and moclobemide: charcoal is superior to lavage[J]. Br J Clin Pharmacol, 2000,49(3):274-278. DOI: 10.1046/j.1365-2125.2000.00138.x .
返回引文位置Google Scholar
百度学术
万方数据
[19]
中国医师协会急诊医师分会,中国毒理学会中毒与救治专业委员会. 急性中毒诊断与治疗中国专家共识[J]. 中华急诊医学杂志, 2016,25(11):1361-1375. DOI: 10.3760/cma.j.issn.1671-0282.2016.11.004 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Hopkins LE , Sunkersing J , Jacques A . Too many pills to swallow: a case of a mixed overdose[J]. J Intensive Care Soc, 2017,18(3):247-250. DOI: 10.1177/1751143717693860 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Alshaya OA , Alhamed A , Althewaibi S ,et al. Calcium channel blocker toxicity: a practical approach[J]. J Multidiscip Healthc, 2022,15:1851-1862. DOI: 10.2147/JMDH.S374887 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Levine M , Curry SC , Padilla-Jones A ,et al. Critical care management of verapamil and diltiazem overdose with a focus on vasopressors: a 25-year experience at a single center[J]. Ann Emerg Med, 2013,62(3):252-258. DOI: 10.1016/j.annemergmed.2013.03.018 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Cole JB , Lee SC , Prekker ME ,et al. Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: a comparison of amlodipine versus non-dihydropyridines[J]. Clin Toxicol (Phila), 2022,60(11):1205-1213. DOI: 10.1080/15563650.2022.2131565 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Lavonas EJ , Akpunonu PD , Arens AM ,et al. 2023 American heart association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2023,148(16):e149-e184. DOI: 10.1161/CIR.0000000000001161 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Krenz JR , Kaakeh Y . An overview of hyperinsulinemic-euglycemic therapy in calcium channel blocker and β-blocker overdose[J]. Pharmacotherapy, 2018,38(11):1130-1142. DOI: 10.1002/phar.2177 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Holger JS , Stellpflug SJ , Cole JB ,et al. High-dose insulin: a consecutive case series in toxin-induced cardiogenic shock[J]. Clin Toxicol (Phila), 2011,49(7):653-658. DOI: 10.3109/15563650.2011.593522 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Mégarbane B . High-dose insulin should be used before vasopressors/inotropes in calcium-channel blocker toxicity[J]. Br J Clin Pharmacol, 2023,89(4):1269-1274. DOI: 10.1111/bcp.15641 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Zhang XP , Loke KE , Mital S ,et al. Paradoxical release of nitric oxide by an L-type calcium channel antagonist, the R+ enantiomer of amlodipine[J]. J Cardiovasc Pharmacol, 2002,39(2):208-214. DOI: 10.1097/00005344-200202000-00007 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Biao X , Li XH , Gao L ,et al. Amlodipine, but not verapamil or nifedipine, dilates rabbit femoral artery largely through a nitric oxide- and kinin-dependent mechanism[J]. Br J Pharmacol, 2002,136(3):375-382. DOI: 10.1038/sj.bjp.0704753 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Rietjens SJ , van Riemsdijk TE , Sikma MA ,et al. High-dose insulin should NOT be used without vasopressors in calcium channel blocker toxicity[J]. Br J Clin Pharmacol, 2023,89(4):1275-1278. DOI: 10.1111/bcp.15642 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Howarth DM , Dawson AH , Smith AJ ,et al. Calcium channel blockin drug overdose: an Australian series[J]. Hum Exp Toxicol, 1994,13(3):161-166. DOI: 10.1177/096032719401300304 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Ramoska EA , Spiller HA , Winter M ,et al. A one-year evaluation of calcium channel blocker overdoses: toxicity and treatment[J]. Ann Emerg Med, 1993,22(2):196-200. DOI: 10.1016/s0196-0644(05)80202-1 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Ramoska EA , Spiller HA , Myers A . Calcium channel blocker toxicity[J]. Ann Emerg Med, 1990,19(6):649-653. DOI: 10.1016/s0196-0644(05)82469-2 .
返回引文位置Google Scholar
百度学术
万方数据
[34]
Masson R , Colas V , Parienti JJ ,et al. A comparison of survival with and without extracorporeal life support treatment for severe poisoning due to drug intoxication[J]. Resuscitation, 2012,83(11):1413-1417. DOI: 10.1016/j.resuscitation.2012.03.028 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Weiner L , Mazzeffi MA , Hines EQ ,et al. Clinical utility of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) in patients with drug-induced cardiogenic shock: a retrospective study of the Extracorporeal Life Support Organizations ' ECMO case registry [J]. Clin Toxicol (Phila), 2020,58(7):705-710. DOI: 10.1080/15563650.2019.1676896 .
返回引文位置Google Scholar
百度学术
万方数据
[36]
Finn D , Stevens J , Tolkacz M ,et al. Calcium channel blocker overdose: what role does extracorporeal membrane oxygenation have in support? A systematic review of the literature[J]. ASAIO J, 2024,70(5):404-408. DOI: 10.1097/MAT.0000000000002129 .
返回引文位置Google Scholar
百度学术
万方数据
[37]
Vandroux D , Aujoulat T , Gaüzère BA ,et al. Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication: a single-center cohort study[J]. World J Emerg Med, 2022,13(4):283-289. DOI: 10.5847/wjem.j.1920-8642.2022.070 .
返回引文位置Google Scholar
百度学术
万方数据
[38]
Hofer CA , Smith JK , Tenholder MF . Verapamil intoxication: a literature review of overdoses and discussion of therapeutic options[J]. Am J Med, 1993,95(4):431-438. DOI: 10.1016/0002-9343(93)90314-f .
返回引文位置Google Scholar
百度学术
万方数据
[39]
Fettiplace MR , Weinberg G . The mechanisms underlying lipid resuscitation therapy[J]. Reg Anesth Pain Med, 201 8 ,43(2):138-149. DOI: 10.1097/AAP.0000000000000719 .
返回引文位置Google Scholar
百度学术
万方数据
[40]
Rothschild L , Bern S , Oswald S ,et al. Intravenous lipid emulsion in clinical toxicology[J]. Scand J Trauma Resusc Emerg Med, 2010,18:51. DOI: 10.1186/1757-7241-18-51 .
返回引文位置Google Scholar
百度学术
万方数据
[41]
Sebe A , Dişel NR , Açıkalın Akpınar A ,et al. Role of intravenous lipid emulsions in the management of calcium channel blocker and β-blocker overdose: 3 years experience of a university hospital[J]. Postgrad Med, 2015,127(2):119-124. DOI: 10.1080/00325481.2015.1012480 .
返回引文位置Google Scholar
百度学术
万方数据
[42]
Doepker B , Healy W , Cortez E ,et al. High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock induced by intentional calcium-channel blocker and Beta-blocker overdose: a case series[J]. J Emerg Med, 2014,46(4):486-490. DOI: 10.1016/j.jemermed.2013.08.135 .
返回引文位置Google Scholar
百度学术
万方数据
[43]
Cao DZ , Heard K , Foran M ,et al. Intravenous lipid emulsion in the emergency department: a systematic review of recent literature[J]. J Emerg Med, 2015,48(3):387-397. DOI: 10.1016/j.jemermed.2014.10.009 .
返回引文位置Google Scholar
百度学术
万方数据
[44]
Levine M , Hoffman RS , Lavergne V ,et al. Systematic review of the effect of intravenous lipid emulsion therapy for non-local anesthetics toxicity[J]. Clin Toxicol (Phila), 2016,54(3):194-221. DOI: 10.3109/15563650.2015.1126286 .
返回引文位置Google Scholar
百度学术
万方数据
[45]
Toxicology ACOM . ACMT position statement: guidance for the use of intravenous lipid emulsion[J]. J Med Toxicol, 2017,13(1):124-125. DOI: 10.1007/s13181-016-0550-z .
返回引文位置Google Scholar
百度学术
万方数据
[46]
Smolinske S , Hoffman RS , Villeneuve E ,et al. Utilization of lipid emulsion therapy in fatal overdose cases: an observational study[J]. Clin Toxicol (Phila), 2019,57(3):197-202. DOI: 10.1080/15563650.2018.1504954 .
返回引文位置Google Scholar
百度学术
万方数据
[47]
Perichon D , Turfus S , Gerostamoulos D ,et al. An assessment of the in vivo effects of intravenous lipid emulsion on blood drug concentration and haemodynamics following oro-gastric amitriptyline overdose [J]. Clin Toxicol (Phila), 2013,51(4):208-215. DOI: 10.3109/15563650.2013.778994 .
返回引文位置Google Scholar
百度学术
万方数据
[48]
Cole JB , Stellpflug SJ , Engebretsen KM . Asystole immediately following intraven ous fat emulsion for overdose [J]. J Med Toxicol, 2014,10(3):307-310. DOI: 10.1007/s13181-014-0382-7 .
返回引文位置Google Scholar
百度学术
万方数据
[49]
Levine M , Skolnik AB , Ruha AM ,et al. Complications following antidotal use of intravenous lipid emulsion therapy[J]. J Med Toxicol, 2014,10(1):10-14. DOI: 10.1007/s13181-013-0356-1 .
返回引文位置Google Scholar
百度学术
万方数据
[50]
Warrick BJ , Tataru AP , Smolinske S . A systematic analysis of methylene blue for drug-induced shock[J]. Clin Toxicol (Phila), 2016,54(7):547-555. DOI: 10.1080/15563650.2016.1180390 .
返回引文位置Google Scholar
百度学术
万方数据
[51]
Wong A , Hoffman RS , Walsh SJ ,et al. Extracorporeal treatment for calcium channel blocker poisoning: systematic review and recommendations from the EXTRIP workgroup[J]. Clin Toxicol (Phila), 2021,59(5):361-375. DOI: 10.1080/15563650.2020.1870123 .
返回引文位置Google Scholar
百度学术
万方数据
[52]
李辉,任珍,郭治国. 急性钙通道阻滞剂中毒的临床特征研究[J]. 中国全科医学, 2023,26(14):1758-1765. DOI: 10.12114/j.issn.1007-9572.2022.0798 .
返回引文位置Google Scholar
百度学术
万方数据
[53]
Beyls C , Malaquin S , Huette P ,et al. Hemodynamic impact of molecular adsorbent recirculating system in refractory vasoplegic shock due to calcium channel blocker poisoning[J]. Int J Artif Organs, 2021,44(12):944-951. DOI: 10.1177/03913988211007865 .
返回引文位置Google Scholar
百度学术
万方数据
[54]
Pichon N , Dugard A , Clavel M ,et al. Extracorporeal albumin dialysis in three cases of acute calcium channel blocker poisoning with life-threatening refractory cardiogenic shock[J]. Ann Emerg Med, 2012,59(6):540-544. DOI: 10.1016/j.annemergmed.2011.07.029 .
返回引文位置Google Scholar
百度学术
万方数据
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
评论 (0条)
注册
登录
时间排序
暂无评论,发表第一条评论抢沙发
MedAI助手(体验版)
文档即答
智问智答
机器翻译
回答内容由人工智能生成,我社无法保证其准确性和完整性,该生成内容不代表我们的态度或观点,仅供参考。
生成快照
文献快照

你好,我可以帮助您更好的了解本文,请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持:

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号