氯氮平所致心律失常的临床相关因素分析

目的探讨氯氮平治疗患者心律失常状况及其相关因素。方法对500例服用氯氮平住院患者治疗前后心率、心律、心脏传导改变及其影响因素进行病例对照研究分析。结果氯氮平治疗后有61例(12.2%)患者出现有临床意义的心律失常(符合以下中的一项:①窦性心率≥140次/分或心率≥130次/分且T波异常;②出现频发早搏(≥3次/分)、严重心律改变;③出现心脏传导障碍),氯氮平导致有临床意义心律失常的危险因素有:血药浓度较高、服药剂量较大、用药早期以及联用多种(≥3种)精神药物。结论氯氮平易导致具临床意义的心律失常,不宜首选用药,临床中须严格监测。

The Investigation Into the Clinical Risk Factors of Clozapine induced Arrhythmia

Objective To explore the state of clozapine induced arrhythmia and its associated clinical risk factors.Method 500 inpatients were treated with clozapine and measured heart rate,heart rhythm,cardiac conduction changes before and after treatment.We compared the clinical factors,such as age,sex,pre-medication,co-medication,pre-existing cardiovascular disease,patients＇ physical condition before the therapy,duration of applied clozapine and therapeutic doses etc.,between the patients with and without arrhythmia.Results There are 61 patients（12.2%） that showed clinically significant arrhythmia（one of the following in： ①Heart rate ≥140 beats / min or a heart rate ≥130 beats/min and T wave abnormalities;②There is frequent premature beats（≥ 3 times/min）,severe heart rhythm changes;③Cardiac conduction disturbances） after treatment with clozapine.The major clinical factors associated with this side effect were as follows： higher plasma clozapine concentration,higher dose of clozapine,the beginning of treatment and co-administration of several psychotropic drugs（≥3 species）.Conclusions Clozapine might induce clinical significant arrhythmia in patients,which suggest that clozapine is not suitable to be used as the first-line psychotropic drug,and it is necessary to monitor its electrocardiogram strictly.