两例由利培酮诱发的危及生命的心律失常：利培酮和9-羟基利培酮浓度评估
Two cases of life-threatening arrhythmia induced by risperidone: evaluation of risperidone and 9-hydroxy-risperidone concentrations.
作者信息
Ito Asami, Enokiya Tomoyuki, Kawamoto Eiji, Iwashita Yoshiaki, Takeda Taichi, Ikemura Kenji, Okuda Masahiro, Imai Hiroshi
机构信息
Emergency and Critical Care Center Mie University Hospital Tsu Japan.
Department of Pharmacy Mie University Hospital Tsu Japan.
出版信息
Acute Med Surg. 2017 Apr 24;4(3):341-343. doi: 10.1002/ams2.277. eCollection 2017 Jul.
CASES
Case 1: A 20-year-old woman suffering a suspected overdose was transported to the hospital. She presented bradycardia with wide QRS waves and QT prolongation, followed by cardiac arrest. Extracorporeal cardiopulmonary resuscitation was implemented, improving circulation. Risperidone and 9OH-RIS levels were 9.6 ng/mL and 127.6 ng/mL, respectively. Case 2: A 54-year-old woman was hospitalized for femoral fracture and underwent surgery. Her electrocardiogram showed bradycardia and complete AV block. Risperidone and 9OH-RIS levels were 3.2 ng/mL and 61.4 ng/mL, respectively.
OUTCOME
In both cases, only serum concentration of 90H-RIS were elevated.
CONCLUSION
Arrhythmia related to risperidone has proven rare but sometimes fatal. Serum concentrations of risperidone and the metabolite 9-hydroxy-risperidone (9OH-RIS) during these events are seldom documented. As 9OH-RIS shows pharmacological activity equivalent to risperidone, it may induce life-threatening arrhythmia (regardless of the intake dosage). It is critical to evaluate the serum concentration of 9OH-RIS in suspected risperidone toxicity.
病例
病例1：一名疑似药物过量的20岁女性被送往医院。她出现了伴有宽QRS波和QT间期延长的心动过缓，随后发生心脏骤停。实施了体外心肺复苏，循环得到改善。利培酮和9-羟基利培酮（9OH-RIS）水平分别为9.6 ng/mL和127.6 ng/mL。病例2：一名54岁女性因股骨骨折住院并接受手术。她的心电图显示心动过缓和完全性房室传导阻滞。利培酮和9OH-RIS水平分别为3.2 ng/mL和61.4 ng/mL。
结果
在这两个病例中，仅90H-RIS的血清浓度升高。
结论
与利培酮相关的心律失常已被证实罕见但有时致命。这些事件期间利培酮及其代谢产物9-羟基利培酮（9OH-RIS）的血清浓度很少有记录。由于9OH-RIS显示出与利培酮相当的药理活性，它可能诱发危及生命的心律失常（无论摄入剂量如何）。在疑似利培酮中毒时评估9OH-RIS的血清浓度至关重要。
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