電子期刊
台灣家庭醫學雜誌
綜論(Review Article)
血清素(Serotonin)症候群
serotonin syndrome、serotonin uptake inhibitors、monoamine oxidase inhibitors、neuroleptic malignant syndrome
陳進明1
、廖浩欽1
林口長庚醫學中心急診醫學科 醫師1
抗憂鬱藥使用大幅的成長,其中以選擇性血清素再吸收抑制劑的成長佔了大部分,血清素症候群發生機會因而大為的昇高。但是血清素症候群的非特異性、輕微且與其他疾病症狀多所重疊,很容易被忽略而無法早期確認早期處置,造成了醫師與病患間的不少困擾。 血清素症候群是藥物副作用,一般認為是特異體質所引起,可能發生在單獨使用選擇性血清素再吸收抑制劑,或合併使用單胺氧化?抑制劑、三環抗憂鬱藥,甚至是鋰鹽等都是可能的病因。診斷上需要病史、理學檢查以及與惡性類神經藥物症候群作鑑別診斷。病理生理機轉是由於突觸內的血清素的作用或活性的增加,但其血清濃度在實驗室檢查多半是在正常範圍。治療首重在找出致病的藥物,立即停止使用,再加上合併症如橫紋肌溶解合併急性腎臟衰竭、呼吸衰竭等的預防以及處置。死亡率約為2.4%。
SSRIs are one of the most frequently prescribed antidepressant agents. SSRIs are associated with very few unwanted pharmacological actions. The most serious adverse effect of SSRI pharmacotherapy is potentially to develop serotonin syndrome. All SSRIs predispose to serotonin syndrome, especially when combined with other serotonergic agents such as MAOIs. The most common symptoms seen in serotonin syndrome include nausea, vomiting, drowsy, tremor, tachycardia, mild hypertension, dyskinesia, seizure and coma. Ancillary studies are usually normal in serotonin syndrome. All serotonin syndrome patients require immediate emergency physician evaluation especially to distinguish from NMS. These patients occasionally develop life-threatening complications. The mortality rate in serotonin syndrome is approximately 2.4%.
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