Barrueto Fermin, Murr Indira, Meltzer Andrew, Brewer Kori, Meggs William
University of Maryland School of Medicine, Baltimore, MD 21201, USA.
J Med Toxicol. 2006 Dec;2(4):147-51. doi: 10.1007/BF03161182.
Antiarrhythmics can have devastating effects in cardiotoxic poisonings. Amiodarone is recommended for treatment of wide complex tachycardia, but its hemodynamic effects in wide complex tachycardia induced by tricyclic antidepressant poisoning are unknown. The objective of this study was to compare the effects of sodium bicarbonate, amiodarone, and normal saline in treating wide complex tachycardia secondary to nortriptyline poisoning.
This unblended randomized controlled animal study involved 18 anesthetized, intubated pigs with arterial and venous lines. Nortriptyline (2 mg/mL) was infused at 20 mg/min until the onset of toxicity, defined as a systolic blood pressure < or =50 mmHg or QRS > or =120 ms. At that point, the pigs were randomized into three groups of six. Group I received 0.9% normal saline, 10 ml/kg. Group II received hypertonic sodium bicarbonate, 1 mEq/kg. Group III received amiodarone, 15 mg/kg. The pigs were observed until death or survival at 60 minutes.
After treatment, the changes in QRS were as follows: Group I, -2.0 ms; Group II, -33.0 ms; Group III, -21.7 ms. ANOVA demonstrated no significant difference between the groups (p = 0.28). Mean arterial pressures 10 minutes after treatment were as follows: Group I, 19.4 mmHg; Group II, 23.7 mmHg; Group III, 12.5 mmHg. Based on ANOVA, there was no significant difference between any of the groups (p = 0.50).
In this model of nortriptyline poisoning, the administration of amiodarone to correct wide complex tachycardia did not have a harmful effect.
抗心律失常药物在心脏中毒时可能产生严重后果。胺碘酮被推荐用于治疗宽QRS波心动过速，但其在三环类抗抑郁药中毒所致宽QRS波心动过速中的血流动力学效应尚不清楚。本研究的目的是比较碳酸氢钠、胺碘酮和生理盐水治疗去甲替林中毒继发宽QRS波心动过速的效果。
本非盲随机对照动物研究纳入18只麻醉、插管并置有动静脉导管的猪。以20mg/min的速度输注去甲替林（2mg/mL）直至出现毒性反应，毒性反应定义为收缩压≤50mmHg或QRS间期≥120ms。此时，将猪随机分为三组，每组6只。第一组给予0.9%生理盐水，10ml/kg。第二组给予高渗碳酸氢钠，1mEq/kg。第三组给予胺碘酮，15mg/kg。观察猪60分钟，直至死亡或存活。
治疗后，QRS间期变化如下：第一组，-2.0ms；第二组，-33.0ms；第三组，-21.7ms。方差分析显示各组间无显著差异（p = 0.28）。治疗后10分钟的平均动脉压如下：第一组，19.4mmHg；第二组，23.7mmHg；第三组，12.5mmHg。基于方差分析，各组间无显著差异（p = 0.50）。
在该去甲替林中毒模型中，使用胺碘酮纠正宽QRS波心动过速并无有害影响。
