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中国临床药理学与治疗学 ›› 2024, Vol. 29 ›› Issue (7): 819-825.doi: 10.12092/j.issn.1009-2501.2024.07.012

• 临床药理学 • 上一篇    下一篇

曲马多诱导的低血糖的临床特征分析

刘伟,何琴,何怡然   

  1. 湖南中医药大学第一附属医院药学部,长沙  410007,湖南
  • 收稿日期:2023-07-20 修回日期:2024-01-10 出版日期:2024-07-26 发布日期:2024-06-24
  • 通讯作者: 何怡然,女,硕士,主管中药师,研究方向:临床药学。 E-mail: heyiranheyiran@163.com
  • 作者简介:刘伟,男,中药师,研究方向:临床药学。 E-mail: 768892327@qq.com
  • 基金资助:
    湖南中医药大学科研基金项目(2019XJJJ055)

Analysis of clinical characteristics of tramadol induced hypoglycemia

LIU Wei, HE Qin, HE Yiran   

  1. Department of Pharmacy, The First Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan, China
  • Received:2023-07-20 Revised:2024-01-10 Online:2024-07-26 Published:2024-06-24

摘要:

目的:探讨曲马多诱导的低血糖的临床特点。方法:通过检索中英文数据从建库起至2023年4月28日,收集曲马多诱导的低血糖的病例报告。结果:20例患者被纳入,中位年龄为50岁(4,88)。低血糖发生在给药后1 h~23 d,血糖的中位值为2.25 mmol/L(0.22,3.3),曲马多的中位日剂量为300 mg(1.53,14 000)。临床主要表现为昏迷(12例),多器官功能衰竭(7例),心肺骤停(7例),癫痫发作(4例),嗜睡(3例)和出汗(3例)等。6例患者报告了曲马多血药浓度,中位值为3.56 mg/L(0.47,9.4)。20例患者停用曲马多,给予对症支持治疗后,16例患者恢复,1例患者中度脑功能障碍,3例患者死亡。结论:曲马多诱导的低血糖可发生在给药后1 h~23 d,临床可表现为自主神经系统症状和神经低血糖症状,以神经低血糖症状为主。停用曲马多后大部分患者低血糖可恢复正常,严重者可死亡。

关键词: 曲马多, 低血糖, 止痛药, 阿片类, 不良反应

Abstract:

AIM: To investigate the clinical characteristics of tramadol-induced hypoglycemia. METHODS: Case reports of tramadol-induced hypoglycemia were collected by searching Chinese and English data from the database establishment to April 28, 2023. RESULTS: Twenty patients were included, with a median age of 50 years (4, 88). Hypoglycemia occurred 1 h-23 d after tramadol administration, with a median blood glucose of 2.25 mmol/L  (0.22, 3.3) and a median daily dose of 300 mg (1.53, 14 000). The main clinical manifestations were unconscious (12 cases), multiple organ failure (7 cases), asystole and/or apnea (7 cases), seizures (4 cases), somnolence (3 cases) and sweating (3 cases).Tramadol concentrations were reported in 6 patients, with a median of 3.56 mg/L (0.47, 9.4). After stopping tramadol in 20 patients and giving symptomatic supportive treatment, 16 patients recovered, 1 patient had moderate brain dysfunction, and 3 patients died. CONCLUSION: Tramadol induced hypoglycemia can occur from 1 h to 23 d after administration, and can be clinically manifested as autonomic nervous system symptoms and neurohypoglycemia symptoms, mainly neurohypoglycemia symptoms. After stopping tramadol, most patients with hypoglycemia returned to normal, and severe patients can die.

Key words: tramadol, hypoglycemia, analgesics, opioid, adverse drug reactions

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