在急性抗精神病药物中毒中延长QT间隔:系统审查和建议
Ingrid Berling1,2, Christopher Yates3, Robert S Hoffman4
1Department of Clinical Toxicology and the Department Emergency Medicine, Calvary Mater Newcastle, Newcastle, Australia.
Clinical toxicology (Philadelphia, Pa.)
|November 19, 2025
概括
过量服用抗精神病药物可以延长QT间隔,增加心律失常的风险. 建议查心电图和针对性心脏监测特定的高风险抗精神病药物,如阿米苏普里德, thioridazine 和ziprasidone.
科学领域:
- 临床毒理学 临床毒理学
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 抗精神病药物经常与QT间隔延长有关,这种情况可以导致危险的心室失律症,如torsade de pointes.
- 目前用于管理抗精神病药物过量和QT间隔延长风险的患者的临床实践通常涉及广泛的心脏监测,导致患者处置的延迟和医疗保健成本的增加.
- 缺乏基于证据的指导方针使得对这些中毒患者的评估和管理变得复杂.
研究的目的:
- 为在急性抗精神病药物过量服用的患者中评估和管理QT间隔延长制定基于证据的建议.
- 为此患者群体提供有关适当使用心脏监测的指导.
- 解决临床毒理学标准化方案的需要.
主要方法:
- 进行了一次系统的文献审查,以确定急性过量服用中QT间隔延长的研究,特别关注抗精神病药物过量服用.
- 总结了证据,并起草了关于QT间隔监测的投票陈述.
- 为了在监测建议上达成专家共识,采用了经过修改的Delphi方法,涉及两轮.
主要成果:
- 在审查的327篇文章中,55篇与过量服用抗精神病药物引起的QT延长有关.
- 在所有抗精神病药物过量服用时,建议对心电图进行风险评估.
- 建议在特定高剂量摄入时 (阿米苏普里德>2g, thioridazine>1g,ziprasidone>3g) 进行持续的心脏监测,并建议在较低剂量和其他特定药物 (haloperidol,iloperidone,pimozide,pipamperone) 时进行持续心脏监测;对于克洛扎平,risperidone, olanzapine 或 quetiapine 则不建议.
结论:
- 对于所有急性抗精神病药物过量服用病例,建议进行查心电图.
- 针对性持续的心脏监测建议用于涉及蒂奥里达辛,阿米苏普里德和齐普拉西的过量服用,建议采用利,伊洛皮,皮帕和皮莫齐德的方法.
- 抗精神病药物过量服用的torsade de pointes的风险可能被高估为一个类别,特定药物引起更大的关注.
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