利多卡因治疗美沙酮诱发的尖端扭转型室性心动过速。

Treatment of methadone-induced torsades de pointes with lidocaine.

作者信息

Rajpal Saurabh, Mundi Amandeep S, Reddy Pratap C, Akkus Nuri I

出版信息

J La State Med Soc. 2013 Nov-Dec;165(6):338-41.

Abstract

Methadone maintenance treatment (MMT) is commonly used for chronic pain control and for substitution in heroin addicts undergoing rehabilitation. Methadone is known to prolong QT interval and sometimes cause torsade de pointes (TdP) and ventricular fibrillation (VF). Treatment of TdP by antiarrhythmic drugs that prolong QT interval may worsen TdP. To our knowledge, worsening of methadone-induced TdP by amiodarone has not been reported before. We describe here a case of methadone-induced TdP that deteriorated into ventricular fibrillation upon treatment with intravenous (IV) amiodarone and resolved after discontinuation of amiodarone and treatment with IV magnesium, potassium, and lidocaine.

摘要

美沙酮维持治疗（MMT）常用于慢性疼痛控制以及对正在接受康复治疗的海洛因成瘾者进行替代治疗。已知美沙酮会延长QT间期，有时会导致尖端扭转型室速（TdP）和心室颤动（VF）。使用延长QT间期的抗心律失常药物治疗TdP可能会使TdP恶化。据我们所知，此前尚未有胺碘酮使美沙酮诱导的TdP恶化的报道。我们在此描述一例美沙酮诱导的TdP病例，该病例在静脉注射胺碘酮治疗后恶化为心室颤动，在停用胺碘酮并使用静脉注射镁、钾和利多卡因治疗后得以缓解。