Di Salvo T G, O'Gara P T
Cardiac Unit, Massachusetts General Hospital, Boston 02114, USA.
Clin Cardiol. 1995 May;18(5):285-90. doi: 10.1002/clc.4960180512.
Intravenous haloperidol is the agent of choice for controlling severe agitated delirium in seriously ill cardiac patients in many institutions. Prior reports have proposed that high-dose intravenous haloperidol may be without untoward effects in these patients. Recently, however, a few reports of significant QTc prolongation and torsade de pointes as complications of high-dose intravenous haloperidol therapy have appeared. The present report describes three patients with definite haloperidol-induced QTc prolongation and torsade. In each case, QTc prolongation preceded the arrhythmia and disappeared following the discontinuation of haloperidol. Neither electrolyte imbalance, therapy with other cardiac drugs, bradycardia, ischemia, left ventricular dysfunction, nor other known cause of torsade was present in these patients. It is hypothesized that QTc prolongation and torsade likely are idiosyncratic, unpredictable reactions to high-dose haloperidol in select patients. Careful serial electrocardiographic monitoring and prompt discontinuation of the drug should suffice to prevent this relatively uncommon, life-threatening complication of high-dose intravenous haloperidol.
在许多机构中，静脉注射氟哌啶醇是控制重症心脏病患者严重激越性谵妄的首选药物。先前的报告提出，高剂量静脉注射氟哌啶醇对这些患者可能没有不良影响。然而，最近有一些报告称，高剂量静脉注射氟哌啶醇治疗会出现显著的QTc延长和尖端扭转型室速等并发症。本报告描述了3例明确由氟哌啶醇引起QTc延长和尖端扭转型室速的患者。在每例患者中，QTc延长均先于心律失常出现，且在停用氟哌啶醇后消失。这些患者均不存在电解质失衡、使用其他心脏药物治疗、心动过缓、缺血、左心室功能障碍或其他已知的尖端扭转型室速病因。据推测，QTc延长和尖端扭转型室速可能是部分患者对高剂量氟哌啶醇的特异质性、不可预测的反应。严密的系列心电图监测及及时停药应足以预防高剂量静脉注射氟哌啶醇这种相对罕见但危及生命的并发症。
