成人文拉法辛中毒所致心血管毒性：235例连续病例回顾
Cardiovascular toxicity due to venlafaxine poisoning in adults: a review of 235 consecutive cases.
作者信息
Howell C, Wilson A D, Waring W S
机构信息
Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, Edinburgh, UK.
出版信息
Br J Clin Pharmacol. 2007 Aug;64(2):192-7. doi: 10.1111/j.1365-2125.2007.02849.x. Epub 2007 Feb 12.
AIMS
Venlafaxine may increase the risk of arrhythmia in certain patients. We sought to characterize the cardiovascular effects of venlafaxine overdose in adults.
METHODS
A retrospective casenote review of patients admitted to the Royal Infirmary of Edinburgh between January 2000 and June 2006. Haemodynamic and electrocardiographic data were examined in the whole group and a subset that ingested venlafaxine alone.
RESULTS
Two hundred and thirty-five patients (65 men) with median (interquartile range) age 34 years (27-43 years) had ingested venlafaxine 1500 mg (919-2800 mg). Tachycardia (40.0%), high blood pressure (28.4%) and mydriasis (36.6%) were common. Corrected QT >450 ms occurred in seven men (11.1%) and 17 women (10.5%) and transient arrhythmia in three patients. There was a positive correlation between stated quantity of venlafaxine ingested and heart rate [rho = 0.195, 95% confidence interval (CI) 0.054, 0.328] and QTc (rho = 0.314, 95% CI 0.089, 0.509).
CONCLUSIONS
Venlafaxine overdose is associated with sympathomimetic cardiovascular effects and prolonged QTc, irrespective of coingested drugs. These mechanisms might pose an increased risk of arrhythmia and require further exploration.
目的
文拉法辛可能会增加某些患者发生心律失常的风险。我们试图明确成人过量服用文拉法辛后的心血管效应。
方法
对2000年1月至2006年6月间入住爱丁堡皇家医院的患者进行回顾性病例记录审查。对整个组以及单独服用文拉法辛的亚组的血流动力学和心电图数据进行检查。
结果
235名患者（65名男性），年龄中位数（四分位间距）为34岁（27 - 43岁），服用了1500毫克（919 - 2800毫克）文拉法辛。心动过速（40.0%）、高血压（28.4%）和瞳孔散大（36.6%）很常见。7名男性（11.1%）和17名女性（10.5%）出现校正QT>450毫秒，3名患者出现短暂性心律失常。服用的文拉法辛剂量与心率[rho = 0.195，95%置信区间（CI）0.054，0.328]和QTc（rho = 0.314，95%CI 0.089，0.509）之间存在正相关。
结论
无论是否同时服用其他药物，过量服用文拉法辛都与拟交感神经心血管效应和QTc延长有关。这些机制可能会增加心律失常的风险，需要进一步探究。
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