Lawrence K R, Nasraway S A
Critical Care Pharmacy, Deaconess Hospital, Boston, Massachusetts, USA.
Pharmacotherapy. 1997 May-Jun;17(3):531-7.
Droperidol and haloperidol have demonstrated efficacy and safety in the treatment of acute delirium in critically ill patients. We conducted MEDLINE and manual searches of literature published from 1966-1996 to identify articles describing conduction disturbances associated with the drugs. The objectives were to describe the proposed mechanisms of acquired long QTc interval syndrome and torsades de pointes, and to recommend how critically ill patients receiving these agents should be monitored. We found 11 published reports of conduction disturbances associated with intravenous administration of droperidol or haloperidol. The majority of cases occurred in critically ill patients prescribed more than 50 mg/24 hours of either agent. Of the 18 patients described, 13 (72%) had a history of cardiovascular disease. Based on the small number of available case reports, it seems reasonable to suggest that the incidence of adverse cardiovascular effects due to droperidol and haloperidol is small. The mechanism of butyrophenone-induced QTc interval prolongation is not known, but is presumed to involve abnormal ventricular repolarization and the development of early after-depolarizations. Before initiating therapy with droperidol or haloperidol in critically ill patients, a baseline QTc interval and serum magnesium and potassium concentrations should be measured. If the baseline QTc interval is 440 msec or longer, and they are receiving other drugs that may prolong the QTc interval or they have electrolyte disturbances, a butyrophenone antipsychotic should be prescribed with caution. All critically ill patients receiving droperidol or haloperidol should undergo electrocardiogram monitoring and QTc interval measurement; special attention should be given to those receiving doses greater than 50 mg/24 hours, as these patients appear to be at greatest risk for development of conduction disturbances. Based on the currently available literature, in any critically ill patient receiving droperidol or haloperidol therapy whose QTc interval lengthens by 25% or more over baseline, therapy should be discontinued or the dosage reduced.
氟哌利多和氟哌啶醇已被证明在治疗重症患者的急性谵妄方面有效且安全。我们对1966年至1996年发表的文献进行了MEDLINE检索和手工检索，以确定描述与这些药物相关的传导障碍的文章。目的是描述获得性长QTc间期综合征和尖端扭转型室速的推测机制，并建议如何监测接受这些药物治疗的重症患者。我们发现了11篇关于静脉注射氟哌利多或氟哌啶醇相关传导障碍的发表报告。大多数病例发生在服用任一药物超过50mg/24小时的重症患者中。在描述的18例患者中，13例（72%）有心血管疾病史。基于现有的少量病例报告，似乎有理由认为氟哌利多和氟哌啶醇引起的不良心血管效应发生率较低。丁酰苯类药物引起QTc间期延长的机制尚不清楚，但推测涉及心室复极异常和早期后去极化的发生。在对重症患者开始使用氟哌利多或氟哌啶醇治疗前，应测量基线QTc间期以及血清镁和钾浓度。如果基线QTc间期为440毫秒或更长，且他们正在接受其他可能延长QTc间期的药物治疗或存在电解质紊乱，则应谨慎使用丁酰苯类抗精神病药物。所有接受氟哌利多或氟哌啶醇治疗的重症患者都应进行心电图监测和QTc间期测量；应特别关注那些接受剂量大于50mg/24小时的患者，因为这些患者似乎发生传导障碍的风险最大。根据目前可得的文献，在任何接受氟哌利多或氟哌啶醇治疗的重症患者中，如果其QTc间期比基线延长25%或更多，应停药或减少剂量。
