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患儿,男,2岁。因咳漱气喘2天伴哭闹2小时以急性支气管炎予抗感染及退热处理,并予非那更25mg×1/2支肌注。用药30分钟后患儿出现烦躁不安,步态蹒跚,口角流诞,眼周肌内颤搐,头颈斜向右后方,颈项不能转动。立即停用所有药物并检查,发现非那更安瓿为50mg制剂,询问护士说未看剂型只按1/2支肌注医嘱执行。考虑非那更过量。立即予以吸氧输液,654-2等处理3小时,患儿恢复正常。观察2天无上述症状出现. 讨论 非那更为H_1受体阻断药,具有抗组胺及显著的中枢安定作用.小儿每公斤体重用量为0.5～1mg.超量应用易发生中毒。可有口渴、头晕、耳鸣、恶心、便秘、共济失调、烦躁不安、心悸、出汗、休克、昏迷等。如中毒量较大可先见中枢抑制,继而兴奋,最后转为衰竭抑制。非那更中毒的处理主要是对症治疗,其锥体外系反应可用654-2对抗。作用机理可能与纹状体内胆碱能神经元释放的乙酰胆碱与胆碱受体的结合被阻断有关。
Children, male, 2 years old. Due to cough and asthma 2 days with crying for 2 hours with acute bronchitis to anti-infective and antipyretic treatment, and to non-that more 25mg × 1/2 intramuscular injection. 30 minutes after treatment, children with irritability, staggering gait, mouth bouts, intramuscular twitching eyes, head and neck oblique right rear, the neck can not be rotated. Immediately disable all the drugs and check and found that non-ampoules for the 50mg preparations, asked the nurse said not see the dosage form only by 1/2 muscular injection doctor’s order execution. Consider that more than that. Immediately to oxygen infusion, 654-2 and other treatment for 3 hours, children returned to normal. No symptoms observed for 2 days to discuss non-that H_1 receptor blocker with antihistamine and significant central stability role .In children, the amount of body weight per kilogram 0.5 ~ 1mg. Excessive application prone to poisoning. May have thirst, dizziness, tinnitus, nausea, constipation, ataxia, irritability, heart palpitations, sweating, shock, coma and so on. Such as poisoning can see the larger central suppression, then excited, and finally into failure inhibition. Not that more poisoning treatment is mainly symptomatic treatment, its extrapyramidal reaction 654-2 confrontation available. Mechanism of action may be related to the release of acetylcholine and cholinergic receptors released by striatal cholinergic neurons.