Safer D J
J Child Adolesc Psychopharmacol. 1992 Winter;2(4):279-90. doi: 10.1089/cap.1992.2.279.
ABSTRACT The pertinent literature was reviewed on cardiovascular changes induced by psychostimulant medication treatment of hyperactive children. An assessment of 15 controlled studies using test doses of methylphenidate revealed a significant elevation of the resting heart rate in previously unmedicated children (mean + 11 beats/min) but, with continued drug treatment, only a minor insignificant increase (mean + 4 BPM) is observed. Methylphenidate resulted in no consistent or clinically meaningful blood pressure changes (8 studies) and no EKG irregularities (4 studies). Available data for dextroamphetamine and pemoline were less extensive, but showed essentially no significant cardiovascular changes in hyperactive youth. Stimulant overdoses in nonhyperactive children often led to hypertension and tachycardia, but were associated with only one cardiovascular fatality (amphetamine). Comparable studies of these stimulants in adults revealed: (1) tachycardia and hypertension following high test doses of methylphenidate, (2) hypertension but no tachycardia following high test doses of dextroamphetamine, (3) far greater cardiovascular changes following the parenteral administration of stimulants, (4) the development of a prominent degree of tolerance to the cardiovascular effects of stimulants with continued use, (5) very infrequent cardiovascular changes (3%) in medically ill, older adults following stimulant treatment for depression, and (6) infrequent cardiomyopathy and arteritis in association with amphetamine abuse, but not with pemoline or methylphenidate use. The stimulant-induced changes in children are modest in comparison with changes in cardiovascular functioning associated with normal daily activities, and are not comparable to the risks that can occur with tricyclic antidepressants. There appears to be a wide margin of cardiovascular safety when standard psychostimulants are taken orally in customary doses for long periods by hyperactive children. In view of the numerous negative studies, it probably is not essential to monitor heart rate, blood pressure, or EKG prior to or during routine psychostimulant treatment of children and adolescents with ADHD, unless there are comorbid cardiovascular abnormalities.
本文综述了有关精神兴奋剂药物治疗多动症儿童所引起心血管变化的相关文献。对15项使用哌甲酯试验剂量的对照研究进行评估后发现，此前未用药的儿童静息心率显著升高（平均增加11次/分钟），但持续药物治疗后，仅观察到轻微的无显著意义的增加（平均增加4次/分钟）。哌甲酯未导致一致的或具有临床意义的血压变化（8项研究），也未出现心电图异常（4项研究）。右旋苯丙胺和匹莫林的现有数据较少，但显示多动症青少年基本未出现显著的心血管变化。非多动症儿童服用兴奋剂过量常导致高血压和心动过速，但仅与1例心血管死亡病例（苯丙胺）相关。对这些兴奋剂在成人中的类似研究显示：（1）高剂量哌甲酯试验后出现心动过速和高血压；（2）高剂量右旋苯丙胺试验后出现高血压但无心动过速；（3）注射兴奋剂后心血管变化大得多；（4）持续使用后对兴奋剂的心血管作用产生显著耐受性；（5）患有疾病的老年成人在接受兴奋剂治疗抑郁症后很少出现心血管变化（3%）；（6）与苯丙胺滥用相关的心肌病和动脉炎很少见，但与匹莫林或哌甲酯使用无关。与正常日常活动相关的心血管功能变化相比，兴奋剂在儿童中引起的变化较小，且与三环类抗抑郁药可能出现的风险不可比。多动症儿童长期按常规剂量口服标准精神兴奋剂时，心血管安全性似乎有很大余量。鉴于众多阴性研究结果，在对患有注意力缺陷多动障碍的儿童和青少年进行常规精神兴奋剂治疗之前或期间，可能无需监测心率、血压或心电图，除非存在合并的心血管异常情况。
