Ciszowski Krzysztof, Sein Anand Jacek
Klinika Toksykologii i Chorób Srodowiskowych, Uniwersytet Jagielloński, Collegium Medicum w Krakowie.
Przegl Lek. 2011;68(8):422-5.
Olanzapine is an atypical antipsychotic used for many years in the treatment of schizophrenia and bipolar disorder. Poisonings with this medicine can results with cardiotoxic effects in the form of ECG abnormalities.
To evaluate the nature and incidence of electrocardiographic abnormalities in patients with acute olanzapine poisoning.
23 adult (mean age 38.4 +/- 15.5 years) patients with acute olanzapine poisoning, including 10 men (30.4 +/- 8.1 years) and 11 women (45.7 +/- 17.2 years), where 1 man and 1 woman were poisoned twice. The toxic serum level of olanzapine (above 100 ng/mL) was confirmed in each patient.
Evaluation of electrocardiograms performed in patients in the first day of hospitalization with automatic measurement of durations of PQ, QRS and QTc and the identification of arrhythmias and conduction disorders on the basis of visual analysis of the ECG waveforms. Statistical analysis of the results using the methods of descriptive statistics.
The mean durations of PQ, QRS and QTc in the study group were as follows: 135 +/- 23 ms, 91 +/- 12 ms, and 453 +/- 48 ms, respectively. The most common ECG abnormalities were prolonged QTc and supraventricular tachycardia (including sinus tachycardia) - each 22%; less common were ST-T changes (17%) and supraventricular premature complexes (9%), and only in individual cases (4%) ventricular premature complexes, bundle branch block, sinus bradycardia and atrial fibrillation were present.
In the course of acute olanzapine poisonings: (1) prolonged QTc interval is quite common, but rarely leads to torsade de pointes tachycardia; (2) fast supraventricular rhythms are also common, but rarely cause irregular tachyarrhythmias, eg. atrial fibrillation; (3) conduction disorders (atrioventricular blocks, bundle branch blocks) are not typical abnormalities; (4) the observed ECG abnormalities emphasize the need of continuous ECG monitoring in these patients.
奥氮平是一种非典型抗精神病药物，多年来一直用于治疗精神分裂症和双相情感障碍。服用此药中毒可能导致心电图异常形式的心脏毒性作用。
评估急性奥氮平中毒患者心电图异常的性质和发生率。
23例急性奥氮平中毒的成年患者（平均年龄38.4±15.5岁），其中男性10例（30.4±8.1岁），女性11例（45.7±17.2岁），有1名男性和1名女性中毒两次。每位患者均确认奥氮平血清中毒水平（高于100 ng/mL）。
在患者住院第一天进行心电图评估，自动测量PQ、QRS和QTc间期，并通过对心电图波形的视觉分析识别心律失常和传导障碍。使用描述性统计方法对结果进行统计分析。
研究组PQ、QRS和QTc的平均间期如下：分别为135±23 ms、91±12 ms和453±48 ms。最常见的心电图异常是QTc间期延长和室上性心动过速（包括窦性心动过速），各占22%；较少见的是ST-T改变（17%）和室上性早搏复合体（9%），仅个别病例出现室性早搏复合体、束支传导阻滞、窦性心动过缓和心房颤动（4%）。
在急性奥氮平中毒过程中：（1）QTc间期延长相当常见，但很少导致尖端扭转型室性心动过速；（2）快速室上性心律也很常见，但很少引起不规则快速心律失常，如心房颤动；（3）传导障碍（房室传导阻滞、束支传导阻滞）不是典型异常；（4）观察到的心电图异常强调了对这些患者进行持续心电图监测的必要性。
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