锂中毒导致心律失常、血流动力学障碍1例  

Hemodynamics and arrhythmia disorder caused by lithium poisoning:A case report

作　　者：王玉珏 欧阳丽君 马晓倩[1] 许丹焰[2] 陈晓岗[1] 贺莹[1] WANG Yujue;OUYANG Lijun;MA Xiaoqian;XU Danyan;CHEN Xiaogang;HE Ying(Department of Psychiatry,Second Xiangya Hospital,Central South University,National Clinical Research Center on Mental Disorders,Hunan Key Laboratory of Psychiatry and Mental Health,Changsha 410011;Department of Cardiovascular Medicine,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院精神科,国家精神心理疾病临床医学研究中心,精神病学与精神卫生学湖南省重点实验室,长沙410011 [2]中南大学湘雅二医院心血管内科,长沙410011

出　　处：《中南大学学报（医学版）》2024年第1期153-158,共6页Journal of Central South University ：Medical Science

基　　金：国家重点研发计划(2021YFE0191400);中南大学中央高校基本科研业务费专项资金(2023ZZTS0258);湖南省研究生科研创新项目(CX20230330);中南大学湘雅二医院新进员工科研启航计划。

摘　　要：双相情感障碍是指临床上既有躁狂或轻躁狂发作,又有抑郁发作的一类心境障碍。锂盐是治疗双相情感障碍的一线药物,但其治疗剂量与中毒剂量较接近,当血锂浓度超过1.4 mmol/L时即可产生中毒症状,通常包括胃肠道反应和中枢神经系统症状等。心脏毒性在锂中毒相关病例中较为少见,但后果极为严重。本研究报道1例双相情感障碍患者,在每日超医嘱剂量服用碳酸锂缓释片,同时联用其他心境稳定剂后,血锂浓度达到6.08 mmol/L,并出现心律失常、休克、意识障碍、粗大震颤等症状,在经过血液透析等对症支持治疗后,患者躯体症状逐渐缓解。临床医生有必要加强对锂中毒的预防和识别。Bipolar affective disorder refers to a category of mood disorders characterized clinically by the presence of both manic or hypomanic episodes and depressive episodes.Lithium stands out as the primary pharmacological intervention for managing bipolar affective disorder.However,its therapeutic dosage closely approaches toxic levels.Toxic symptoms appear when the blood lithium concentration surpasses 1.4 mmol/L,typically giving rise to gastrointestinal and central nervous system reactions.Cardiac toxicity is rare but serious in cases of lithium poisoning.The study reports a case of a patient with bipolar affective disorder who reached a blood lithium concentration of 6.08 mmol/L after the patient took lithium carbonate sustained-release tablets beyond the prescribed dosage daily and concurrently using other mood stabilizers.This resulted in symptoms such as arrhythmia,shock,impaired consciousness,and coarse tremors.Following symptomatic supportive treatment,including blood dialysis,the patient’s physical symptoms gradually improved.It is necessary for clinicians to strengthen the prevention and recognition of lithium poisoning.

关 键 词：碳酸锂 双相情感障碍 心律失常 窦房结功能障碍 锂中毒 

分 类 号：R595.2[医药卫生—内科学]