Graudins A, Stearman A, Chan B
Department of Emergency Medicine, Westmead Hospital, NSW, Australia.
J Emerg Med. 1998 Jul-Aug;16(4):615-9. doi: 10.1016/s0736-4679(98)00057-2.
The serotonin syndrome is the result of excess stimulation of central nervous 5-hydroxytryptamine (5HT)-1a and 5HT-2 receptors. The diagnosis requires a history of exposure to agents active at serotonin receptors and the presence of alterations in mental status, autonomic instability, and neuromuscular abnormalities such as tremor, hyperreflexia, or myoclonus. In this descriptive case series, five cases of serotonin syndrome are reported. All patients gave a history of recent exposure to one or more serotonergic medications, including moclobemide, paroxetine, sertraline, and venlafaxine, with clinical evidence of serotonin syndrome. All patients were administered cyproheptadine (4-8 mg orally) for serotonergic signs. Three had complete resolution of signs within 2 h of administration. Another two had a residual tremor or hyperreflexia following the first dose, which resolved following a repeat dose. There were no adverse outcomes from cyproheptadine use. The role of specific serotonin receptor antagonists such as cyproheptadine in the treatment of the serotonin syndrome remains to be delineated. Its use should be considered an adjunct to supportive care. Currently, it is unknown whether cyproheptadine modifies patient outcome.
血清素综合征是中枢神经系统5-羟色胺（5HT）-1a和5HT-2受体过度刺激的结果。诊断需要有接触血清素受体活性药物的病史，以及精神状态改变、自主神经不稳定和神经肌肉异常（如震颤、反射亢进或肌阵挛）的存在。在这个描述性病例系列中，报告了5例血清素综合征病例。所有患者都有近期接触一种或多种血清素能药物的病史，包括吗氯贝胺、帕罗西汀、舍曲林和文拉法辛，并有血清素综合征的临床证据。所有患者均口服赛庚啶（4-8毫克）以治疗血清素能症状。3例患者在给药后2小时内症状完全缓解。另外2例患者在首次给药后仍有残留震颤或反射亢进，重复给药后症状缓解。使用赛庚啶未出现不良后果。赛庚啶等特异性血清素受体拮抗剂在血清素综合征治疗中的作用仍有待明确。其使用应被视为支持性治疗的辅助手段。目前，尚不清楚赛庚啶是否会改变患者的预后。
