青少年急性酒精中毒导致的 QTc 延长。

QTc prolongation in adolescents with acute alcohol intoxication.

机构信息

Erasmus School of Health Policy and Management, Erasmus University, Postbus 1738, 3000, Rotterdam, DR, Netherlands.

Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands.

出版信息

Eur J Pediatr. 2022 Jul;181(7):2757-2770. doi: 10.1007/s00431-022-04471-2. Epub 2022 Apr 28.

DOI:10.1007/s00431-022-04471-2

PMID:35482092

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9192465/

Abstract

In adults, alcohol intoxication is associated with prolongation of the QT interval corrected for heart rate (QTc). The QTc is influenced by age and sex. Although alcohol intoxication is increasingly common in adolescents, there are no data on the prevalence of QTc prolongation in adolescents with alcohol intoxication. This study aimed to determine the prevalence of QTc prolongation in adolescents with alcohol intoxication and identify at-risk adolescents. In this observational study including adolescents aged 10-18 years, heart rate and QT interval were automatically assessed from an electrocardiogram (ECG) at alcohol intoxication using a validated algorithm. The QTc was calculated using both the Bazett formula (QTc) and Fridericia formula (QTc). If present, an ECG recorded within 1 year of the date of admission to the emergency department was obtained as a reference ECG. A total of 317 adolescents were included; 13.3% had a QTc and 7.9% a QTc longer than the sex- and age-specific 95th-percentile. None of the adolescents had a QTc or QTc > 500 ms, but 11.8% of the adolescents with a reference ECG had a QTc prolongation of > 60 ms, while no adolescents had a QTc prolongation of > 60 ms. QTc prolongation was mainly attributable to an increase in heart rate rather than QT prolongation, which underlies the differences between QTc and QTc. Male sex and hypokalaemia increased the likelihood of QTc prolongation.Conclusion: QTc prolongation was seen in approximately 10% of the adolescents presenting with alcohol intoxication, and although no ventricular arrhythmias were observed in this cohort, QTc prolongation increases the potential for malignant QT-related arrhythmias. Clinicians must be aware of the possibility of QTc prolongation during alcohol intoxication and make an effort to obtain an ECG at presentation, measure the QT interval, and give an adequate assessment of the findings. We advocate admitting adolescents with alcohol intoxication and QTc prolongation. During hospital admission, we recommend limiting exposure to QTc-prolonging medication, increasing potassium levels to a high-normal range (4.5-5.0 mmol/L) and obtaining a reference ECG at discharge.

摘要

在成年人中，酒精中毒与心率校正 QT 间期延长（QTc）有关。QTc 受年龄和性别影响。尽管青少年中的酒精中毒越来越常见，但目前尚缺乏有关酒精中毒青少年 QTc 延长患病率的数据。本研究旨在确定酒精中毒青少年 QTc 延长的患病率，并确定高危青少年。在这项纳入 10-18 岁青少年的观察性研究中，使用一种经过验证的算法从心电图（ECG）自动评估酒精中毒时的心率和 QT 间期。使用 Bazett 公式（QTc）和 Fridericia 公式（QTc）计算 QTc。如果存在，将在急诊科就诊日期后 1 年内获得 ECG 作为参考 ECG。共纳入 317 名青少年；13.3%的青少年 QTc 和 7.9%的青少年 QTc 长于性别和年龄特异性第 95 百分位数。没有青少年的 QTc 或 QTc>500ms，但 11.8%的有参考 ECG 的青少年 QTc 延长>60ms，而没有青少年的 QTc 延长>60ms。QTc 延长主要归因于心率增加而不是 QT 延长，这是 QTc 和 QTc 之间差异的基础。男性和低钾血症增加了 QTc 延长的可能性。结论：在因酒精中毒就诊的青少年中，约有 10%存在 QTc 延长，尽管在该队列中未观察到室性心律失常，但 QTc 延长增加了恶性与 QT 相关的心律失常的可能性。临床医生必须意识到在酒精中毒期间发生 QTc 延长的可能性，并努力在就诊时获得 ECG，测量 QT 间期，并充分评估检查结果。我们主张收治因酒精中毒和 QTc 延长而就诊的青少年。在住院期间，我们建议限制使用延长 QTc 的药物，将钾水平提高到正常高值范围（4.5-5.0mmol/L），并在出院时获得参考 ECG。