首发精神分裂症患者心电图特征分析
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摘要
目的:探讨首发精神分裂症患者心电图特征以及定期监测心电图对早期发现抗精神病药物所致心脏副作用的意义。方法:选择2016年5-10月住院治疗的首发精神分裂症患者239例,在治疗开始前及应用抗精神病药物治疗后连续6周监测心电图,并在治疗的3、6、9、12月末随访心电图,对结果进行分析。结果:心电图异常诊断及最早检出时间以窦性心率失常为主,占67.33%,其中窦性心动过速31例(30.69%),检出时间(10.65±2.61)天;窦性心律不齐20例(19.80%),检出时间(15.44±1.99)天;窦性心动过缓17例(16.83%),检出时间(13.37±3.10)天;女性患者心电图异常率显著高于男性患者(χ~2=5.89,P<0.05);年龄越大,心电图异常率越高(χ~2=5.18,P<0.05);联合用药患者的心电图异常率显著高于单一用药患者(χ~2=9.32,P<0.01)。结论:抗精神病药物对心肌代谢有不同程度的影响,在治疗过程中定期监测心电图,有助于早期发现抗精神病药物的心脏副作用。
Objective:To explore ECG characteristics of first-episode schizophrenics and significance of regular ECG monitoring for early discovering antipsychotics' side effects on heart.Methods:ECGs were performed before treatment and continuous 6 weeks after treatment in hospitalized 239 first-episode schizophrenics from May.2016 to Oct.follow-up ECGs at the end of month 3,6,9 and 12 during treatment.Results:ECG abnormal diagnosis with earliest detection time was mainly sinus arrhythmia making up 67.33%,31 patients showed nodal tachycardia(30.69%),detection time was(10.65±2.61)days;20 patients showed sinus arrhythmia and detection time was(15.44±1.99)days;17 patients showed sinus bradycardia(16.83%)and detection time was(13.37±3.10)days;ECG abnormal rate was significantly higher in female than that in male patients(χ~2=5.89,P<0.05);the older,the higher ECG abnormal rate(χ~2=5.18,P<0.05);ECG abnormal rate was significantly higher in patients on drug combination than that on single drug(χ~2=9.32,P<0.01).Conclusion:Antipsychotic has different effects on myocardial metabolism and regular ECG monitoring during treatment is conducive to early discovery of antipsychotics' side effects on heart.
Objective:To explore ECG characteristics of first-episode schizophrenics and significance of regular ECG monitoring for early discovering antipsychotics' side effects on heart.Methods:ECGs were performed before treatment and continuous 6 weeks after treatment in hospitalized 239 first-episode schizophrenics from May.2016 to Oct.follow-up ECGs at the end of month 3,6,9 and 12 during treatment.Results:ECG abnormal diagnosis with earliest detection time was mainly sinus arrhythmia making up 67.33%,31 patients showed nodal tachycardia(30.69%),detection time was(10.65±2.61)days;20 patients showed sinus arrhythmia and detection time was(15.44±1.99)days;17 patients showed sinus bradycardia(16.83%)and detection time was(13.37±3.10)days;ECG abnormal rate was significantly higher in female than that in male patients(χ~2=5.89,P<0.05);the older,the higher ECG abnormal rate(χ~2=5.18,P<0.05);ECG abnormal rate was significantly higher in patients on drug combination than that on single drug(χ~2=9.32,P<0.01).Conclusion:Antipsychotic has different effects on myocardial metabolism and regular ECG monitoring during treatment is conducive to early discovery of antipsychotics' side effects on heart.
引文
[1]郝伟,于欣.精神病学[M].7版.北京:人民卫生出版社,2014:93-107
[2]苾为峰,周连勇,李梓萌,等.精神分裂症患者用药依从性及复发情况的调查[J].中华精神科志,2012,4(1):25-28
[3]沈渔邨.精神病学[M].5版.北京:人民卫生出版社,2009:507-518,824-862
[4]郝伟,于欣.精神病学[M].7版.北京:人民卫生出版社,2014:226-246
[5]葛少洁.服用奥氮平与利培酮的精神分裂症患者心电图比较分析[J].黑龙江医学,2015,39(9):1018-1021
[6]De H M,Detraux J,Van W R,et al.Metabolic and cardiovascular adverse effects associated with antipsychotic drugs[J].Nature Reviews Endocrinology,2011,8(2):114-126
[7]葛少洁.服用奥氮平与利培酮的精神分裂症患者心电图比较分析.[J]黑龙江医学,2015,9(39):1018-1020
[8]陈耿谊,高镇松,张胜佳,等.定期监测心电图和心肌酶早期发现抗精神病药心脏副作用研究[J].河北医学,2014,20(9):1427-1430
[9]陈新.黄宛临床心电图学[M].6版.北京:人民卫生出版社,2015:21-286櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏
[10]Wang Y,Chen Z J,Yang Y.Effect and safety of Olanzapine in the treatment of elderly patients with schizophrenia[J].Chin,Jof Health Psychology,2017,25(10):1465-1468
[11]常学润,张敬悬,何云鹏.氨磺必利与氯氮平、阿立哌唑对精神分裂症患者心肌酶和心电图影响的对比研究[J].精神医学杂志,2015,28(2):113-116
[12]席丽.氨磺必利治疗首发精神分裂症疗效及不良反应的观察[J].中国实用医药,2014,96(6):154-155
[13]Zhang C,Wang Y B,Yang Y,et al.The controlled study on Ziprasidone and Risperidone in teatment of first-episode schizophrenia in children and adolescents[J].Chin,J of Health Psychology,2015,23(11):1604-1607
[14]刘明艳.长期住院精神分裂症患者心电图分析[J].中国民康医学,2012,7(13):1579-1580
[15]Suzki Y,Sugai T,Fukui N,et al.Sex differences in the effect of four second-generation antipsychotics on QTc interval in patients with schizophrenia[J].Hum Psychopharmacol,2013,28(3):215-219
[16]吕建宝,曹文胜,康燕霞,等.精神分裂症患者QTc间期延长的影响因素[J].神经疾病与精神卫生,2014,14(4):375-377
[17]Zhou S B,Sun X D,Tian Y L,et al.Effect and safety of magnesium valproate sustained-release tablet in the treat of schizophrenic in patients with aggressive behaviors[J].Chin,J of Health Psychology,2015,23(4):484-487
[18]Blasco-Fontecilla H,Baca-Garcia E,Leon J D.Do atypical antipsychotic drugs reduce the risk of ischemic heart disease and mortality?Possible role of 5-HT2A receptor blockade[J].Schizophrenia Research,2010,119(1):160-163
[2]苾为峰,周连勇,李梓萌,等.精神分裂症患者用药依从性及复发情况的调查[J].中华精神科志,2012,4(1):25-28
[3]沈渔邨.精神病学[M].5版.北京:人民卫生出版社,2009:507-518,824-862
[4]郝伟,于欣.精神病学[M].7版.北京:人民卫生出版社,2014:226-246
[5]葛少洁.服用奥氮平与利培酮的精神分裂症患者心电图比较分析[J].黑龙江医学,2015,39(9):1018-1021
[6]De H M,Detraux J,Van W R,et al.Metabolic and cardiovascular adverse effects associated with antipsychotic drugs[J].Nature Reviews Endocrinology,2011,8(2):114-126
[7]葛少洁.服用奥氮平与利培酮的精神分裂症患者心电图比较分析.[J]黑龙江医学,2015,9(39):1018-1020
[8]陈耿谊,高镇松,张胜佳,等.定期监测心电图和心肌酶早期发现抗精神病药心脏副作用研究[J].河北医学,2014,20(9):1427-1430
[9]陈新.黄宛临床心电图学[M].6版.北京:人民卫生出版社,2015:21-286櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏櫏
[10]Wang Y,Chen Z J,Yang Y.Effect and safety of Olanzapine in the treatment of elderly patients with schizophrenia[J].Chin,Jof Health Psychology,2017,25(10):1465-1468
[11]常学润,张敬悬,何云鹏.氨磺必利与氯氮平、阿立哌唑对精神分裂症患者心肌酶和心电图影响的对比研究[J].精神医学杂志,2015,28(2):113-116
[12]席丽.氨磺必利治疗首发精神分裂症疗效及不良反应的观察[J].中国实用医药,2014,96(6):154-155
[13]Zhang C,Wang Y B,Yang Y,et al.The controlled study on Ziprasidone and Risperidone in teatment of first-episode schizophrenia in children and adolescents[J].Chin,J of Health Psychology,2015,23(11):1604-1607
[14]刘明艳.长期住院精神分裂症患者心电图分析[J].中国民康医学,2012,7(13):1579-1580
[15]Suzki Y,Sugai T,Fukui N,et al.Sex differences in the effect of four second-generation antipsychotics on QTc interval in patients with schizophrenia[J].Hum Psychopharmacol,2013,28(3):215-219
[16]吕建宝,曹文胜,康燕霞,等.精神分裂症患者QTc间期延长的影响因素[J].神经疾病与精神卫生,2014,14(4):375-377
[17]Zhou S B,Sun X D,Tian Y L,et al.Effect and safety of magnesium valproate sustained-release tablet in the treat of schizophrenic in patients with aggressive behaviors[J].Chin,J of Health Psychology,2015,23(4):484-487
[18]Blasco-Fontecilla H,Baca-Garcia E,Leon J D.Do atypical antipsychotic drugs reduce the risk of ischemic heart disease and mortality?Possible role of 5-HT2A receptor blockade[J].Schizophrenia Research,2010,119(1):160-163