Gheshlaghi Farzad, Yaraghi Ahmad, Soh Elahesadat Hashemi, Ghoreishi Ashkan
Department of Clinical Toxicology and Forensic Medicine, Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Med Arh. 2012;66(1):9-11. doi: 10.5455/medarh.2012.66.9-11.
Carbamazepine is an iminostilbene derivative structurally related to cyclic antidepressants which implies its potential cardiotxic properties, especially in acute poisoning. This study aimed to determine the frequency and severity of cardiovascular complications in carbamazepine intoxication and its relationship with level of consciousness.
Patients with carbamazepine intoxication referred to our department recruited using convenience sampling method. Analysis included following parameters: systolic (SBP) and diastolic (DBP) blood pressure, ECG parameters: heart rate (HR), QRS width, PR interval and corrected QT interval (QTc). Relations between features on admission, 12 and 24 hours later and level of consciousness evaluated.
77 patients (28 males, 49 females; median age 25.1) which got our criteria included in this study. QRS complexes in 9 cases (11.7%) were wider than normal and PR interval and corrected QT interval (QTc) were normal. There was no significant relationship between QT interval, QRS width and pulse rate changes with level of consciousness during 24 hours post admission, but blood pressure [systolic, diastolic and mean arterial blood pressure (MABP)] progressively decreased and PR interval changes progressively increased during this period. Further, there was negative correlation just between sever decrease of level of consciousness (coma) and blood pressure [systolic, diastolic and mean arterial blood pressure (MABP)], and positive correlation with QRS complexes widening at 12 hours after admission. There was no correlation between loss of consciousness and diastolic blood pressure, QT interval and PR interval on admission and 12 hours and 24 hours later.
Regarding the relationship between level of consciousness and cardiovascular changes at 12 hours after admission, particular attention on cardiovascular changes and ECG monitoring particularly in intoxicated patients with severe loss of consciousness(coma), should considered; it will lead to prevent unexpected complication, mortality and to decrease the length of hospitalization.
卡马西平是一种亚氨基芪衍生物，在结构上与环类抗抑郁药相关，这意味着它可能具有心脏毒性，尤其是在急性中毒时。本研究旨在确定卡马西平中毒时心血管并发症的发生率和严重程度及其与意识水平的关系。
采用便利抽样法招募转诊至我科的卡马西平中毒患者。分析包括以下参数：收缩压（SBP）和舒张压（DBP）、心电图参数：心率（HR）、QRS波宽度、PR间期和校正QT间期（QTc）。评估入院时、12小时和24小时后的特征与意识水平之间的关系。
77例患者（28例男性，49例女性；中位年龄25.1岁）符合纳入本研究的标准。9例患者（11.7%）的QRS波群增宽，但PR间期和校正QT间期（QTc）正常。入院后24小时内，QT间期、QRS波宽度和脉率变化与意识水平之间无显著关系，但在此期间血压[收缩压、舒张压和平均动脉压（MABP）]逐渐下降，PR间期变化逐渐增加。此外，意识水平严重下降（昏迷）仅与血压[收缩压、舒张压和平均动脉压（MABP）]呈负相关，与入院后12小时QRS波群增宽呈正相关。入院时、12小时和24小时后意识丧失与舒张压、QT间期和PR间期之间无相关性。
考虑到入院后12小时意识水平与心血管变化之间的关系，应特别关注心血管变化和心电图监测，尤其是对意识严重丧失（昏迷）的中毒患者；这将有助于预防意外并发症、降低死亡率并缩短住院时间。
