Eizadi-Mood Nastaran, Sabzghabaee Ali Mohammad, Saghaei Mahmoud, Gheshlaghi Farzad, Mohammad-Ebrahimi Behnaz
Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran.
Med Arh. 2012;66(1):49-52.
Tricyclic antidepressant (TCA) overdose is generally associated with central nervous system (CNS) and cardiovascular toxicity manifested by seizure, electrocardiographic (ECG) abnormalities and arrhythmia. The objective of this study was to determine whether TCA toxicity would be reduced in patient where benzodiazepine (BDZ) was co-ingested with TCA.
Patients who were diagnosed to be poisoned by ingestion of both a tricyclic antidepressant and benzodiazepine (TCA-BDZ), and patients intoxicated solely by a TCA were assessed, provided that they had one or more clinical signs of toxicity (anticholinergic, cardiovascular or CNS findings) and no underlying cardiac disease. TCA poisoned patients who had ingested any drugs other than benzodiazepines were excluded. Patients transferred from elsewhere and those admitted after the first 24 hours were also excluded. The clinical manifestations of TCA toxicity and outcome of the patients poisoned only with TCA (N = 60) were compared with those of the patients who had co-ingested TCAs and BDZs (N = 60).
The frequency distribution of sinus tachycardia, "QRS more than 100 ms, R/S aVR equal or more than 0.7, RaVR equal or more than 3 mm", arrhythmia, and generalized tonic colonic seizure was less in patients who had co-ingested BDZ with TCA. Evaluating the relationship between ingested TCA dosage and electrocardiographic findings (duration of QRS, QT and PR intervals, the amplitude of R wave in lead aVR and right axis deviation) in both study groups, demonstrated that there was a strong relationship between TCA dosage and QRS duration in the TCA group. This was significantly different from the same correlation in the TCA-BDZ group (r, 0.50 in TCA group versus r, 0.04 in TCA and BDZ group, P < 0.05). No significant differences were found in complications (aspiration pneumonia, non-cardiac pulmonary oedema and death) between the two groups.
cardiovascular toxicity and seizure may be less in TCA-BDZ poisoned patients compared with patients intoxicated with TCA-alone.
三环类抗抑郁药（TCA）过量通常与中枢神经系统（CNS）和心血管毒性相关，表现为癫痫发作、心电图（ECG）异常和心律失常。本研究的目的是确定在同时摄入苯二氮䓬（BDZ）和TCA的患者中，TCA毒性是否会降低。
对被诊断为同时摄入三环类抗抑郁药和苯二氮䓬（TCA-BDZ）中毒的患者以及仅因TCA中毒的患者进行评估，前提是他们有一项或多项毒性临床体征（抗胆碱能、心血管或中枢神经系统表现）且无潜在心脏病。排除摄入除苯二氮䓬类药物以外任何其他药物的TCA中毒患者。从其他地方转诊的患者以及在最初24小时后入院的患者也被排除。将仅因TCA中毒患者（N = 60）的TCA毒性临床表现和结局与同时摄入TCA和BDZ的患者（N = 60）进行比较。
同时摄入BDZ和TCA的患者中，窦性心动过速、“QRS超过100毫秒、aVR导联R/S等于或大于0.7、RaVR等于或大于3毫米”、心律失常和全身性强直阵挛性癫痫发作的频率分布较低。评估两个研究组中摄入TCA剂量与心电图表现（QRS、QT和PR间期持续时间、aVR导联R波振幅和电轴右偏）之间的关系，表明TCA组中TCA剂量与QRS持续时间之间存在密切关系。这与TCA-BDZ组中的相同相关性有显著差异（TCA组r为0.50，TCA和BDZ组r为0.04，P < 0.05）。两组之间在并发症（吸入性肺炎、非心源性肺水肿和死亡）方面未发现显著差异。
与仅TCA中毒的患者相比，TCA-BDZ中毒患者的心血管毒性和癫痫发作可能较轻。
