Isbister Geoffrey K, Buckley Nick A
Department of Clinical Toxicology and Pharmacology, Newcastle Mater Misericordiae Hospital and University of Newcastle, NSW, Australia.
Clin Neuropharmacol. 2005 Sep-Oct;28(5):205-14. doi: 10.1097/01.wnf.0000177642.89888.85.
Serotonin toxicity (or serotonin syndrome) has become an increasingly common and important clinical problem in medicine over the last 15 years with the introduction of many new antidepressants that can cause increased levels of serotonin (5-HT) in the central nervous system (CNS). Severe and life-threatening cases are almost exclusively a result of combinations of antidepressants (usually monoamine oxidase inhibitors and selective serotonin reuptake inhibitors). Unfortunately, the term serotonin syndrome has a number of quite different meanings, and many people writing on this subject have failed to differentiate them. This has led to false conclusions regarding the 5-HT receptor subtypes responsible for the life-threatening effects in animal and human toxicity, and suggestions of ineffective treatment strategies. This review primarily addresses the serotonin receptor subtypes that underlie the clinical manifestations of excess CNS serotonin in humans and animals, and their implications for diagnosis and treatment. More specific diagnostic criteria for serotonin toxicity are required to identify situations when specific antidotes are likely to be useful. However, the mainstay of treatment of severe cases is good supportive care and early intubation and paralysis in life-threatening serotonin toxicity.
在过去15年里，随着许多能导致中枢神经系统（CNS）中血清素（5-羟色胺，5-HT）水平升高的新型抗抑郁药的问世，血清素中毒（或血清素综合征）已成为医学领域中日益常见且重要的临床问题。严重且危及生命的病例几乎完全是抗抑郁药联合使用（通常是单胺氧化酶抑制剂和选择性血清素再摄取抑制剂）的结果。不幸的是，血清素综合征这一术语有许多截然不同的含义，许多撰写该主题的人未能对其加以区分。这导致了关于在动物和人类中毒中导致危及生命效应的5-HT受体亚型的错误结论，以及无效治疗策略的建议。本综述主要探讨人类和动物中枢神经系统血清素过量临床表现背后的血清素受体亚型，及其对诊断和治疗的意义。需要更具体的血清素中毒诊断标准来识别可能需要使用特定解毒剂的情况。然而，严重病例治疗的主要支柱是良好的支持性护理以及在危及生命的血清素中毒时尽早进行插管和麻痹。
