目的 通过汇总国内外文献,对药物种类、发生时间、临床症状、严重程度、危险因素进行汇总分析,使医务工作者方便了解抗精神病药物所致横纹肌溶解症(RM) 的临床特点和治疗方法,有利于减少RM的发生和及时诊治。方法 以中英文横纹肌溶解症、各种抗精神病药物为主题词,分别检索万方数据库、CNKI、PubMed和Embase,数据采集1980.1.1~2019.4.1。结果 共入选29例患者,9种药物,奥氮平7例,喹硫平6例,利培酮4例,氟哌啶醇3例,阿立哌唑2例,氯氮平1例,米氮平3例,左美丙嗪1例,克塞平2例。5例单独用药,24例合并其他药物(83%),6名患者进展为急性肾衰竭。RM的临床表现为肌酸激酶升高、肝酶升高、肌痛、肌无力、茶色尿,以上症状不一定同时发生。横纹肌溶解发生时间和药物剂量无关。结论 抗精神病药物可以导致危及生命的横纹肌溶解症,若患者同时接受两种以上药物治疗时,或者伴有其他因素共同存在时,发生率更高。当出现肌痛、肌无力、腹痛、茶色尿,尤其在更换药物、增加剂量时,应及时对患者进行临床实验室检查,判断是否发生RM,以便及时治疗,以免病情恶化。
Abstract
OBJECTIVE Antipsychotic drugs are being widely used for psychiatric disorders, including schizophrenia, bipolar disorders, attention-deficit, autism, depression. Rhabdomyolysis is a rare but potentially serious adverse drug reaction to antipsychotic medicines.To evaluate rhabdomyolysis association with a range of antipsychotic medicines. METHODS Key terms like ‘rhabdomyolysis’ ‘RM’ and ‘antipsychotic’ were used for systematic literature research in Wanfang database, CNKI, Pubmed and Embase respectively. Data collection time ranged from 1980.1.1 to 2019.4.1.RESULTS All the 29 reported cases were absence of NMS. The suspected antipsychotic medicines for these 29 cases were olanzapine (n=7), quetiapine (n=6), risperidone (n=4), haloperidol (n=3), aripiprazole (n=2), clozapine (n=1), mitazapine (n=3), levomepromazine (n=1), loxapine(n=2). Twenty-four (83%) patients were taking two or more medicines. Symptoms of rhabdomyolysis includes muscle pain,weakness in mobility, changes in urine color. Not all patients showed such symptoms. Six cases developed AKI. There is no relationship between the onset of rhabdomyolysis and antipsychotic medicines dosages. CONCLUSION Antipsychotic drugs use is associated with an increased risk of rhabdomyolysis. It seems more common in those taking polypharmacy. Patients and caregivers should pay attention to the symptoms of muscle pain,weakness in mobility, abdominal pain, changes in urine color, especially dosage increment or starting a new medication.
关键词
横纹肌溶解症 /
抗精神病药物 /
肌酸激酶
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Key words
rhabdomyolysis /
antipsychotic /
creatine phosphokinases
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