氨磺必利致窦性停搏  

Sinus arrest caused by amisulpride

作　　者：裴可灵 吴钰倩 周莉[1] 路淑淑 张涛 Pei Keling;Wu Yuqian;Zhou Li;Lu Shushu;Zhang Tao(Department of Pharmacy,Shandong Mental Health Center Affiliated to Shandong University,Ji′nan 250014,China;Department of Pharmacy,Shandong Electric Power Central Hospital,Ji′nan 250001,China)

机构地区：[1]山东大学附属精神卫生中心药学部,济南250014 [2]山东电力中心医院药学部,济南250001

出　　处：《药物不良反应杂志》2024年第6期379-381,共3页Adverse Drug Reactions Journal

基　　金：山东省医学会临床科研专项基金(YXH2020ZX059);山东省中医药科技基金(M-2022200)。

摘　　要：1例65岁女性偏执型精神分裂症患者因利培酮治疗效果欠佳换用氨磺必利,逐渐增加剂量(0.1 g、2次/d,服用3 d;0.2 g、2次/d,服用2 d;最后加量至每天早晨0.4 g、每晚0.2 g)。4 d后心电图示窦性心动过缓,心率49次/min,QT间期492 ms;7 d后动态心电图示最慢心率25次/min,平均42次/min,窦性停搏(17 h大于2.0 s的R-R间期共207阵,最长2.47 s),停搏大多发生于夜间。将氨磺必利减量为0.2 g口服、1次/d,给予心电监测,次日心脏彩色多普勒超声示左室运动不良、二尖瓣反流(轻度)、左室充盈异常。考虑患者窦性停搏可能与氨磺必利有关,立即停用该药,奥氮平由5 mg/d加量至10 mg/d,其他治疗不变。停药次日,心电监测中窦性停搏次数较前明显减少,停药3 d后动态心电图未出现窦性停搏;停药26 d后心电图显示窦性心律,心率60次/min。A 65-year-old female patient with paranoid schizophrenia switched to amisulpride due to poor treatment efficacy with risperidone,and gradually increased the dosage(0.1 g twice daily for 3 days,0.2 g,twice daily for 2 days,and finally 0.4 g in the morning and 0.2 g in the evening).After 4 days of medication,electrocardiogram showed sinus bradycardia,with heart rate 49 beats/min and QT interval 492 ms;after 7 days of medication,dynamic electrocardiogram showed heart rate 25 beats/min(average heart rate 42 beats/min)and sinus arrest(207 R-R intervals greater than 2.0 s,with a maximum of 2.47 s).Sinus arrest in the patient mostly occurred at night.Amisulpride was reduced to 0.2 g once daily orally,and ECG monitoring was given.The next day,echocardiography showed left ventricular dyskinesia,mild mitral regurgitation,and abnormal left ventricular filling.It was considered that sinus arrest may be related to amisulpride.The drug was discontinued immediately,the dose of olanzapine increased from 5 mg/d to 10 mg/d,and other treatments remain unchanged.On the day after discontinuation of amisulpride,the number of sinus arrest in electrocardiogram monitoring significantly decreased compared to before.Three days after discontinuation,no sinus arrest was found on the dynamic electrocardiogram;26 days later,the ECG showed sinus rhythm,with a heart rate of 60 beats/min.

关 键 词：老年人 精神分裂症 偏执型 氨磺必利 窦性停搏 药物不良反应 

分 类 号：R969[医药卫生—药理学]