一位中年女性三環抗憂鬱劑過量後反覆發作癲癇的案例報告

Abstract

三環抗憂鬱劑為抗憂鬱用藥之一，在過量時患者可能會出現抗膽鹼症狀、甚至是具有致死風險的中樞神經以及心血管毒性症狀。本篇案例報告介紹一位中年女性因三環抗憂鬱劑中毒而導致意識不清、呼吸衰竭以及癲癇反覆發作，接受緊急氣管內管插管以及鎮靜藥物治療後仍未見改善，但因並未出現典型的抗膽鹼症狀，在十二導程心電圖檢查以及一系列毒藥物篩檢確立診斷後，始接受碳酸氫鈉藥物治療、抗癲癇藥物的控制以及後續血管收縮藥物的支持，其後順利康復。筆者希望藉由此案例分享，以及中毒的臨床症狀、診斷和治療等介紹，能增加臨床同仁對三環抗憂鬱劑中毒的認識，也提醒同仁臨床病人藥物過量時常合併多種藥物使用，使得所謂毒性症候群表現往往不典型，因而增加臨床上診斷的困難度和挑戰性，結合病史詢問、理學檢查以及實驗室檢查仍然是早期診斷藥物中毒的不二法門  Tricyclic antidepressants are a class of antidepressants, an overdose of which may cause anticholiner­gic syndromes. In severe cases, fatal central nervous system failure and cardiovascular toxicity may occur. This case report describes a middle-aged female patient who was suffered from unconscious­ness, respiratory failure, and recurrent seizures due to tricyclic antidepressant toxicity. Emergent endotracheal intubation and sedative drug treatment were failed to improve her condition. Given the absence of typical anticholinergic symptoms, the diagnosis was established followed by a 12-lead elec­trocardiogram examination and a series of toxic-drug screening. The patient received treatments with sodium bicarbonate, anti-epileptic drugs, and vasopressor support, which led to full recovery from the intoxication. The authors expect that by sharing this case and introducing the clinical symptoms, diagnosis, and treatment of tricyclic antidepressant-induced toxicity, clinicians could be more familiar with this syndromes. We would like to remind our peers that in clinical settings, patients presenting with drug overdose often took several drugs concomitantly. As such, the toxic syndrome is often atyp­ical which increases the difficulty of clinical diagnosis. The combination of medical history inquiry, physical examination, and laboratory tests remains the key for diagnosing drug toxicity at the early stage.