利培酮所致心电图异常的临床分析

Clinical analysis on abnormal electrocardiogram induced by risperidone

目的了解利培酮所致心电图异常的临床特点及转归。方法收集2013年6月至2014年6月在杭州市富阳区第三人民医院精神科住院并初次应用利培酮治疗患者的病历资料进行回顾性分析，分析指标为利培酮致心电图异常发生率［包括心电图异常总发生率、利培酮不同剂量组（以〈4 mg/d为低剂量组，4～6 mg/d为高剂量组）心电图异常发生率、不同用药时间心电图异常发生率（按用药1、2、3个月分别统计）］和心电图异常的表现、治疗及转归。结果纳入分析的患者为293例，低剂量组135例（男性70例，女性65例，年龄22～68岁），高剂量组158例（男性77例，女性81例，年龄24～63岁）。利培酮所致心电图异常者总发生率为39.60%（116/293），低剂量组与高剂量组心电图异常发生率差异无统计学意义［37.78%（51/135）比41.14%（65/158）, χ^2=0.344, P=0.502］。心电图异常均发生在用药的前3个月内，第1、2、3个月心电图异常发生率分别为16.72%（49/293）、14.75%（36/244）和14.90%（31/208）。低剂量组用药第1、2、3个月心电图异常发生率 ［16.30%（22/135）、14.16%（16/113）和13.40%（13/97）］与高剂量组［17.09%（27/158）、15.27%（20/131）和16.22%（18/111）］比较差异均无统计学意义（均P＞0.017），2组均以用药第1个月心电图异常发生率最高。利培酮所致心电图异常主要表现为窦性心动过速、窦性心动过缓、窦性心律不齐、ST-T改变、房室传导阻滞、QT 间期延长等。出现心电图异常的116例患者中，7例未停药、给予支持治疗后恢复正常，31例未停药、给予对症治疗后恢复正常，3例减少利培酮剂量后恢复正常，75例停用利培酮后恢复正常。结论利培酮所致心电图异常以窦性心律失常较为多见，多发生在用药早期，与用药剂量没有明显关系，经适当处理后可完全恢复。

Objective To understand the clinical characteristics and outcomes of electrocardiogram （ECG） abnormalities induced by risperidone.MethodsMedical records of patients, who had hospitalized in Department of Psychiatry, Hangzhou Fuyang Third People′s Hospital and treated with risperidone for the first time from June 2013 to June 2014, were collected and retrospectively analyzed. The incidences [including the total incidence of ECG abnormalities, incidence in the low dose （〈4 mg/d） group and the high dose （4-6 mg/d） group, incidence at different time of treatment （1, 2, 3 months of treatment）], characteristics, treatments, and outcomes of ECG abnormalities were analyzed.ResultsA total of 293 patients were enrolled into this study. Of them, 135 patients （70 males and 65 females with age from 22 to 68） were in the low dose group and 158 patients （77 males and 81 females with age from 24 to 63） were in the high dose group. The total incidence of ECG abnormalities was 39.60% （116/293） and the difference between the low dose and the high dose groups was not statistically significant [37.78%（51/135） vs. 41.14%（65/158）, χ^2=0.344, P=0.502]. All ECG abnormalities appeared within 3 months of treatment, the incidences in the 1, 2, and 3 months were 16.72%（49/293）, 14.75%（36/244）, and 14.90%（31/208）, respectively. The incidences in the 1, 2, and 3 months were 16.30% （22/135）, 14.16% （16/113）, 13.40% （13/97） in the low dose group and 17.09% （27/158）, 15.27% （20/131）, 16.22% （18/111） in the high dose group, respectively. There were no statistical significance between the 2 groups （all P〉0.017） . The incidence of ECG abnormalities was the highest in the first month of treatment in the 2 groups. The main characteristics of abnormal ECG induced by risperidone were sinus tachycardia, sinus tachycardia, sinus arrhythmia, ST-T changes, atrioventricular block, QT interval prolongation, etc. Of the 116 patients with ECG abnormalities, 7 patients′ risperidone treatments were not stopped and no any other treatments were given, 31 patients′ risperidone treatments were not stopped and symptomatic treatments were given, 3 patients were given a lower dosage of risperidone, and 75 patients′ risperidone treatments were stopped. All patients′ ECG returned to normal.ConclusionsSinus arrhythmia was more common in the ECG abnormalities caused by risperidone. ECG abnormalities appeared mostly in the early stage of risperidone treatment, had no significant relationship with the dosage, and could return entirely to normal.