Torsade de pointes as a complication of subarachnoid hemorrhage - A critical reappraisal
Torsade de pointes as a complication of subarachnoid hemorrhage - A critical reappraisal
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DOI：
10.1016/s0022-0736(97)80032-5
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发表时间：
1997-01-01
影响因子：
1.3
通讯作者：
Lehmann, MH
中科院分区：
文献类型：
--
作者：
Machado, C;Baga, JJ;Lehmann, MH
蛛网膜下腔出血被广泛认为是尖端扭转型室性心动过速（TdP）的潜在原因，但这种假定的病因学关系从未得到系统评价。因此，我们进行了MEDLINE检索从1966年到1993年，相关的反向引用，并确定了20例TdP的设置蛛网膜下腔出血。在这些病例中，不可能完全排除TdP的一种或多种替代解释（通常是因为数据不足），包括先天性长QT综合征、低钾血症、低镁血症或药物诱导的QT间期延长。此外，在16个前瞻性蛛网膜下腔出血系列中的1,139例患者中，仅报告了5例TdP病例，均为低钾血症患者。因此，支持蛛网膜下腔出血可能是TdP的一个独特原因的观点的科学数据非常有限。在获得更明确的证据之前，蛛网膜下腔出血患者TdP的发生可能更好地描述为发生在急性，通常是重症监护环境中的多因素现象。
Subarachnoid hemorrhage is widely accepted as a potential cause of torsade de pointes (TdP), yet this putative etiologic relationship has never been systematically evaluated. We therefore undertook a MEDLINE search from 1966 through 1993, with relevant back referencing, and identified 20 cases of TdP in the setting of subarachnoid hemorrhage. It was impossible in any of these cases (usually because of insufficient data) to completely exclude one or more alternative explanations for TdP, including congenital long QT syndrome, hypokalemia, hypomagnesemia, or drug-induced QT prolongation. Furthermore, of a total of 1,139 patients in 16 prospective series of sub arachnoid hemorrhage with electrographic analyses, there were only five reported cases of TdP, all in patients with hypokalemia. Thus, extremely limited scientific data exist to support the notion that subarachnoid hemorrhage can be a distinct cause of TdP. Until more definitive evidence is available, the development of TdP in patients with subarachnoid hemorrhage is probably better characterized as a multifactorial phenomenon occurring in an acute, typically intensive care, setting.