Prospective multicenter evaluation of tramadol exposure.
Prospective multicenter evaluation of tramadol exposure.
复制标题
曲马多暴露的前瞻性多中心评估。
DOI：
10.3109/15563659709043367
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Deborah L. Anderson
中科院分区：
文献类型：
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作者：
H. Spiller;S. Gorman;D. Villalobos;B. E. Benson;D. Ruskosky;Margaret M. Stancavage;Deborah L. Anderson
背景
曲马多是一种新型镇痛药，具有阿片和去甲肾上腺素作用。其滥用可能性较低，建议增加使用，但有关过量服用毒性的数据有限。
方法
多中心前瞻性病例系列。 1995 年 10 月至 1996 年 8 月向七个毒物中心报告的所有暴露情况均经过评估。
结果
共有 126 例，其中 87 例仅使用曲马多。在单独使用曲马多的病例中，51 例为女性（59%）。年龄范围为 1 至 86 岁，平均年龄和中位数分别为 26.8 岁 (SD 17.2) 和 25 岁。 6岁以下儿童15例。服用过量后报告的症状为：嗜睡 26 例（30%）、恶心 12 例（14%）、心动过速 11 例（13%）、躁动 9 例（10%）、癫痫发作 7 例（8%）、昏迷和高血压各 4 例（5%）、呼吸抑制 2 例（2%）。所有癫痫发作都是短暂的。纳洛酮逆转了 8 名患者中 4 名的镇静和呼吸暂停。一名患者在服用纳洛酮后立即出现癫痫发作。其他治疗包括：地西泮（3 名患者）、苯妥英、劳拉西泮和硝苯地平（各 1 名患者）。曲马多 500 mg 是与癫痫发作、心动过速、高血压或躁动相关的最低剂量，而 800 mg 是与昏迷和呼吸抑制相关的最低剂量。对 19 名患者进行的尿液药物筛查显示阿片类药物呈阴性。所有有症状的病例均在摄入后 4 小时内表现出影响。平均住院时间为 15.2 小时（范围 2-96 小时，SD 15.8）。 19 名患者被送入重症监护室，平均住院时间为 25 小时 (SD 20)。
讨论
曲马多过量的大部分毒性似乎归因于单胺摄取抑制，而不是阿片类药物的作用。烦躁、心动过速、精神错乱和高血压提示可能存在轻度血清素综合征。除了心动过速之外，没有发现任何心律失常。
结论
这项研究表明曲马多过量会产生显着的神经毒性。没有发现严重的心血管毒性。
BACKGROUND
Tramadol is a novel analgesic possessing both opiate and noradrenergic effects. Its low potential for abuse suggests increasing use, but there are limited data on the toxicity in overdose.
METHODS
Multicenter prospective case series. All exposures from October 1995 through August 1996 reported to seven Poison Centers were evaluated.
RESULTS
There were 126 cases of which 87 were tramadol alone. Of the tramadol alone cases, 51 were female (59%). Age ranged from 1 to 86 y with a mean and median of 26.8 y (SD 17.2) and 25 y, respectively. There were 15 cases of children less than 6 years old. Symptoms reported with overdose were: lethargy 26 (30%), nausea 12 (14%), tachycardia 11 (13%), agitation 9 (10%), seizures 7 (8%), 4 each (5%) of coma and hypertension, and respiratory depression 2 (2%). All seizures were brief. Naloxone reversed sedation and apnea in 4 of 8 patients. One patient experienced a seizure immediately after administration of naloxone. Other treatments were: diazepam (3 patients), and phenytoin, lorazepam and nifedipine (1 patient each). Tramadol 500 mg was the lowest dose associated with seizure, tachycardia, hypertension or agitation while 800 mg was the lowest dose associated with coma and respiratory depression. Urine drug screens performed on 19 patients were negative for opiates. All symptomatic cases exhibited effects within 4 h of ingestion. Mean hospital stay was 15.2 h (range 2-96 h, SD 15.8). Nineteen patients were admitted to an intensive care unit with a mean stay of 25 h (SD 20).
DISCUSSION
Much of the toxicity in tramadol overdose appears to be attributable to the monoamine uptake inhibition rather than its opioid effects. Agitation, tachycardia, confusion and hypertension suggest a possible mild serotonin syndrome. No arrhythmias beyond tachycardia were seen.
CONCLUSION
This study suggests significant neurologic toxicity from tramadol overdose. Serious cardiovascular toxicity was not seen.