Evaluation Of The Effect Of Hemoperfusion In The Treatment Of Clozapine Poisoning In Children

Objective:Analyzing the clinical effect of hemoperfusion(HP) in treatment of pediatric patients with clozapine poisoning, in order to verify the clinical application value of HP in treatment of clozapine poisoning in pediatric patients.Methods:All pediatric patients with clozapine poisoning admitted to Hunan Children's Hospital from August 2008 to October 2015 were included in study. All pediatric patients were divided into HP group and non-HP group based on whether HP add-on or not and the clinical indexes were compared between the two groups. To the HP group, the changes of plasma concentration of clozapine and laboratory indexes were analyzed before and after HP. According to the severity of the disturbance of consciousness on admission, excluding consciousness patients, the remaining cases points to three groups, group A(coma children), group B(somnolence children), group C(lethargy children), then divided A,B,C three groups into two subgroups respectively, HP group and non-HP group, compared the time of recovery, the hospitalization expenses, the total duration of hospitalization and the days of hospitalized in PICU.Results:(1)A total of 61 cases, 33 cases were male, 28 were female, the median age were 34(23.50 ~ 45.00) months.(2)Clozapine poisoning can damage multiple body system, the nervous system is most often involved,it's composition is 34.27%,cardiovascular system is 20.22% and respiratory system is 16.29%,digestive system, immune system, etc. can be involved also.(3)There were no statistically significant differences about fever, disturbance of consciousness, convulsions, abnormal muscular tension, reduction of muscle strength, abnormalities of knee jerk, abnormal pupillary light reflex, salivation, gastrointestinal bleeding between HP group and non-HP group(P>0.05), while the differences about incidence of disturbance of dyspnea, pulmonary rales, tachycardia, anemia difference between these two groups were statistically significant(P<0.05).(4)The median plasma concentration of clozapine before and after HP was 410.82(264.47~576.41)ng/ml and 66.06(20.35~103.36) ng/ml respectively,the difference about serum concentration of clozapine between before and after HP(P<0.05).(5)In group A, the median recovery time of consciousness and the median hospitalization time in HP group were 26.50(16.75-44.50)h?6.50(4.25-8.75)days respectively,while in non-HP group were 48.00(40.50-71.50)h?11.00(7.50-13.00)days,the recovery time of consciousness and the hospitalization time in HP group were less than that in non-HP group(P<0.05).The hospitalization expenses and the days of hospitalized in PICU had no statistically significant between these two groups(P>0.05). The median plasma concentration of clozapine after the first time of HP and the first time of elimination half- life in group A was 90.56(20.31-103.13)ng/ml and 261.19(148.06-294.70)ng/ml respectively, the difference of plasma concentration of clozapine between after the first time of HP and the first time of elimination half- life in group A was statistically significant(P<0.05).(6)In group B, the median recovery time of consciousness and the median hospitalization time in HP group were 24.50(12.25-45.75)h?6.50( 5.00-9.00) days respectively, while in non-HP group was 66.50(27.00-80.25)h?11.00(6.75-15.75)days,the recovery time of consciousness and the hospitalization time in HP group were less than that in non-HP group(P<0.05).The hospitalization expenses and the days of hospitalized in PICU had no statistically significant between these two groups(P>0.05). The median plasma concentration of clozapine after the first time of HP and the first time of elimination half- life in group B was 76.23(19.90-103.44)ng/ml and 249.36(84.10-326.87)ng/ml respectively, the difference of plasma concentration of clozapine between after the first time of HP and the first time of elimination half- life in group B was statistically significant(P<0.05).(7)In group C, the median recovery time of consciousness in HP group were 13.00(7.00-24.00)h,while in non-HP group were 23.00(18.00-32.00)h,the recovery time of consciousness in HP group were less than that in non-HP group(P<0.05). In group C, the median days of hospitalized in PICU and the median hospitalization expenses in HP group were 5.50( 4.00-7.00) days and 8936.12(9584.25-11423.38)yuan respectively, while in non-HP group were 3.00(0.00-4.00) days and 4138.81(2637.38-5972.06)yuan, the days of hospitalized in PICU and the hospitalization expenses in HP group were more than that in non-HP group(P<0.05). While the hospitalization time had no statistically significant between these two groups(P>0.05). The median plasma concentration of clozapine after the first time of HP and the first time of elimination half- life in group C was 45.89(20.26-112.76) ng/ml and 181.25(121.04-238.45) ng/ml respectively, the difference of plasma concentration of clozapine between after the first time of HP and the first time of elimination half- life in group C was statistically significant(P<0.05).Conclusion:Conventional therapy combined with HP can rapidly reduce the blood drug concentration, significantly shorten the consciousness recovery time in pediatric patients with clozapine poisoning. About somnolence or coma pediatric patients, HP can significantly reduce the time of hospitalization and shorten the course of disease.