Isbister Geoffrey K, Balit Corrine R
University of Newcastle, Waratah, Australia.
Ann Pharmacother. 2003 Jul-Aug;37(7-8):999-1002. doi: 10.1345/aph.1C481.
To investigate the cardiotoxicity of bupropion hydrochloride in deliberate self-poisoning.
A prospective study was conducted in a national poisons information center (PIC) of cases of adult deliberate self-poisoning with medical record follow-up of the patients. Fifty-nine cases of bupropion deliberate self-poisoning managed in the hospital, in which the New South Wales PIC was contacted for advice, were evaluated from November 2000 through July 2001. Clinical effects and electrocardiographic (ECG) parameters (QRS, QT, QTc) were the main outcome measures.
ECGs were available for 17 of the 59 patients for analysis, 9 patients (53%) were women, and median patient age was 28 years (interquartile range 22-37). The mean +/- SD ingested bupropion dose was 3.8 +/- 3.1 g. Tachycardia occurred in 13 patients (76%; 95% CI 50 to 93) and hypertension in 8 patients (47%). There were no reports of hypotension or arrhythmias. There was a significantly increased QTc of 461 +/- 34 msec in the patients with bupropion overdose compared with previously developed controls; 13 of the 17 cases had a QTc >440 msec (76%; 95% CI 50 to 93). The uncorrected QT interval did not differ from that of controls.
A moderately prolonged QTc (>440 msec) is common in bupropion overdose. However, this may not be a result of intrinsic cardiac toxicity, but overcorrection of the QTc due to the tachycardia that occurs. It is important that the QTc is interpreted with caution in overdoses of agents that cause significant tachycardia (>100 beats/min).
探讨盐酸安非他酮在蓄意自我中毒中的心脏毒性。
在国家毒物信息中心（PIC）对成年蓄意自我中毒病例进行前瞻性研究，并对患者进行病历随访。对2000年11月至2001年7月在医院处理的59例安非他酮蓄意自我中毒病例进行评估，这些病例曾联系新南威尔士州毒物信息中心寻求建议。主要观察指标为临床效应和心电图（ECG）参数（QRS、QT、QTc）。
59例患者中有17例可获得心电图用于分析，9例患者（53%）为女性，患者年龄中位数为28岁（四分位间距22 - 37岁）。摄入的安非他酮平均剂量为3.8±3.1 g。13例患者（76%；95%可信区间50%至93%）出现心动过速，8例患者（47%）出现高血压。未报告有低血压或心律失常。与先前建立的对照组相比，安非他酮过量患者的QTc显著延长至461±34毫秒；17例病例中有13例QTc>440毫秒（76%；95%可信区间50%至93%）。未校正的QT间期与对照组无差异。
安非他酮过量时QTc适度延长（>440毫秒）较为常见。然而，这可能不是心脏内在毒性的结果，而是由于发生的心动过速导致QTc过度校正。对于导致显著心动过速（>100次/分钟）的药物过量情况，谨慎解读QTc非常重要。
