Wilens T E, Stern T A, O'Gara P T
Psychiatric Consultation Service, Massachusetts General Hospital, Boston 02114.
J Clin Psychopharmacol. 1990 Feb;10(1):51-4. doi: 10.1097/00004714-199002000-00010.
During a retrospective review of 70 consecutive intensive care unit admissions for tricyclic antidepressant (TCA) overdose, we identified 12 patients (17%) who had simultaneously ingested a neuroleptic agent. We then compared several clinical and laboratory features of patients who had ingested TCAs alone with those patients who had also taken a neuroleptic drug. The 12 patients in the TCA-neuroleptic group, when compared with patients in the TCA-only group, showed a markedly higher prevalence of first-degree atrioventricular block (p less than 0.001), a significantly higher prevalence of prolongation of the QRS duration (greater than 0.10 sec) (p less than 0.05), and a threefold increase in the prevalence of QTc prolongation (p less than 0.05). Our data indicate that coingestion of neuroleptics and TCAs, when compared with the ingestion of TCA alone, may significantly increase the risk of adverse cardiac consequences. We discuss the possible mechanisms for these electrocardiographic changes as well as their potential implications.
在对70例因三环类抗抑郁药（TCA）过量而连续入住重症监护病房的病例进行回顾性研究时，我们确定了12例（17%）同时摄入了抗精神病药物的患者。然后，我们比较了单纯摄入TCA的患者与同时服用了抗精神病药物的患者的一些临床和实验室特征。与仅服用TCA的患者相比，TCA-抗精神病药物组的12例患者一度房室传导阻滞的发生率明显更高（p<0.001），QRS时限延长（>0.10秒）的发生率显著更高（p<0.05），QTc延长的发生率增加了两倍（p<0.05）。我们的数据表明，与单纯摄入TCA相比，同时摄入抗精神病药物和TCA可能会显著增加不良心脏后果的风险。我们讨论了这些心电图变化的可能机制及其潜在影响。
