Hatta K, Takahashi T, Nakamura H, Yamashiro H, Endo H, Kito K, Saeki T, Masui K, Yonezawa Y
Department of Psychiatry, Tokyo Metropolitan Bokuto Hospital, Japan.
Pharmacopsychiatry. 1998 Jul;31(4):126-30. doi: 10.1055/s-2007-979313.
Arrhythmogenic effects of phenothiazines appear to be associated with sudden death, whereas respiratory complications have received little attention. In this report we describe 5 cases with accompanying obstruction of the airways after intramuscular injections of levomepromazine (LPZ), a potent sedative phenothiazine, in combination with intravenous injections of benzodiazepine (BZ) during a 3-month period in a psychiatric intensive care unit. Two out of 5 cases were unpredictable because obstruction of the airways occurred 2 hours or more after the last injection. As compared with patients who received parenteral (intravenous or intramuscular) injections during the same period, the dose of intramuscular LPZ was significantly large in the 5 cases with obstruction of the airways. All 5 of these cases received intramuscular LPZ 0.52 mg/kg or more. In contrast, there was no patient with obstruction of the airways who received only intramuscular LPZ, the combination of LPZ and HDL, or BZ and HDL. The occurrence of obstruction of the airways among patients who received both intramuscular LPZ and intravenous BZ was significantly higher than among patients who received other drug regimes. These preliminary results suggest that the intramuscular use of LPZ with intravenous BZ may be a risk for obstruction of the airways.
吩噻嗪类药物的致心律失常作用似乎与猝死有关，而呼吸并发症却很少受到关注。在本报告中，我们描述了在一家精神科重症监护病房的3个月期间内，5例在肌肉注射强效镇静吩噻嗪类药物左美丙嗪（LPZ）并静脉注射苯二氮䓬（BZ）后出现气道梗阻的病例。5例中有2例情况不可预测，因为气道梗阻发生在最后一次注射后2小时或更久。与同期接受胃肠外（静脉或肌肉）注射的患者相比，5例气道梗阻患者的肌肉注射LPZ剂量显著更高。这5例患者均接受了0.52mg/kg或更高剂量的肌肉注射LPZ。相比之下，没有仅接受肌肉注射LPZ、LPZ与高密度脂蛋白（HDL）联合用药、或BZ与HDL联合用药的患者出现气道梗阻。接受肌肉注射LPZ和静脉注射BZ的患者中气道梗阻的发生率显著高于接受其他药物治疗方案的患者。这些初步结果表明，肌肉注射LPZ与静脉注射BZ联用可能存在气道梗阻风险。
