Isbister Geoffrey K, Duffull Stephen B
aDepartment of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle Hospital, Newcastle, Australia.
Int Clin Psychopharmacol. 2009 Jul;24(4):174-80. doi: 10.1097/YIC.0b013e32832bb078.
To investigate factors that predict the probability and duration of mechanical ventilation in quetiapine overdose, and if cardiac toxicity occurs, this cohort study involved 176 patients presenting to a toxicology unit on 286 occasions with quetiapine overdose. Patient demographics, dose, coingestants, single dose activated charcoal (SDAC) administration, requirement for and duration of mechanical ventilation and electrocardiogram parameters (heart rate, QT, QRS) were obtained. A fully Bayesian approach using logistic regression and time-to-event analysis was undertaken to investigate the relationship between predictor variables and the requirement for and duration of intubation. QT versus heart rate was plotted on a QT nomogram to investigate QT prolongation. The commonest clinical effects were central nervous system depression on 136 occasions (48%) and tachycardia (67%). There were no malignant arrhythmias and an abnormal QT occurred in only 24 admissions (8.4%), all with tachycardia. Hypotension (systolic blood pressure <90 mmHg) occurred on 35 occasions (12%). The logistic regression model supported dose and SDAC (<2 h) influencing the probability of intubation, but not age, sex, therapeutic use of quetiapine or coingestants. The probability of intubation was 10% after 2 g, 22% after 5 g, 37% after 10 g and 55% after 20 g and SDAC resulted in a reduced probability of intubation of 7% for 2 g ingestion. The median duration of ventilation was 22 h (interquartile: 19-28 h), which was not affected by SDAC. Ingested dose can inform early decision making about requirements for intensive care unit admission and intubation. SDAC seems to have only modest effects on outcomes but may be considered within 2 h for large ingestions. Electrocardiogram monitoring is unlikely to be necessary.
为了研究预测喹硫平过量时机械通气的可能性和持续时间的因素，以及是否会发生心脏毒性，这项队列研究纳入了176例因喹硫平过量286次就诊于毒理学科室的患者。获取了患者的人口统计学资料、剂量、合并摄入物质、单剂量活性炭（SDAC）的使用情况、机械通气的需求及持续时间以及心电图参数（心率、QT、QRS）。采用基于逻辑回归和事件发生时间分析的全贝叶斯方法，研究预测变量与插管需求及持续时间之间的关系。将QT与心率绘制在QT列线图上，以研究QT延长情况。最常见的临床效应是136次（48%）出现中枢神经系统抑制和心动过速（67%）。未出现恶性心律失常，仅24例（8.4%）入院时QT异常，均伴有心动过速。低血压（收缩压<90 mmHg）出现35次（12%）。逻辑回归模型支持剂量和SDAC（<2小时）影响插管的可能性，但年龄、性别、喹硫平的治疗用途或合并摄入物质则无影响。摄入2 g后插管的可能性为10%，5 g后为22%，10 g后为37%，20 g后为55%，摄入2 g时使用SDAC可使插管可能性降低7%。通气的中位持续时间为22小时（四分位间距：19 - 28小时），不受SDAC影响。摄入剂量可为重症监护病房入院和插管需求的早期决策提供参考。SDAC似乎对结局只有适度影响，但对于大量摄入者可在2小时内考虑使用。心电图监测可能没有必要。
