Nishimura Takeshi, Maruguchi Hayato, Nakao Atsunori, Nakayama Shinichi
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan.
Department of Plastic Surgery, Kobe University Hospital, Kobe, Japan.
BMJ Case Rep. 2017 Oct 10;2017:bcr-2017-219257. doi: 10.1136/bcr-2017-219257.
Althoughtricyclic antidepressants(TCAs) are frequently prescribed to patients with depression, these drugs can also be misused. A 21-year-old comatose patient was referred to our hospital presenting with ventricular tachycardia. Despite initial treatment including intravascular lipid emulsion, ventricular fibrillation occurred soon after arrival. Venoarterial extracorporeal membrane oxygenation and therapeutic hypothermia were administered. Refractory arrhythmia disappeared on the next day. A high concentration of amitriptyline was identified in his blood samples on arrival. Mechanical bowel obstruction followed after abdominal compartment syndrome caused by anticholinergic effects, and refractory seizure occurred due to TCA intoxication. Although seizure was brought under control with anticonvulsant agents, his Glasgow Coma Scale did not recover to the full score. MRI presented irreversible damage to the bilateral frontal lobe and insula. Amitriptyline has the potential to cause unusual serious complications, such as abdominal compartment syndrome, irreversible central nervous system disability and lethal arrhythmia.
尽管三环类抗抑郁药（TCAs）经常被开给抑郁症患者，但这些药物也可能被滥用。一名21岁的昏迷患者被转诊至我院，表现为室性心动过速。尽管进行了包括血管内脂质乳剂在内的初始治疗，但患者到达后不久就发生了心室颤动。给予了静脉-动脉体外膜肺氧合和治疗性低温。次日，难治性心律失常消失。患者到达时血液样本中检测到高浓度的阿米替林。抗胆碱能作用导致腹腔间隔室综合征后出现机械性肠梗阻，且因三环类抗抑郁药中毒发生难治性癫痫。尽管使用抗惊厥药物控制了癫痫发作，但他的格拉斯哥昏迷量表评分并未恢复到满分。磁共振成像显示双侧额叶和岛叶有不可逆损伤。阿米替林有可能导致异常严重的并发症，如腹腔间隔室综合征、不可逆的中枢神经系统残疾和致命性心律失常。
