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有几则报告显示,氟西汀(fluoxetine,抗抑郁剂)与亲脂性β-阻滞剂相互作用,能引起心动过缓和晕厥。本文报道1例男性病人,服用氟西汀和普萘洛尔(propranolol)后,引起了完全性心脏阻滞。 患者:男,53岁,因头晕、不适、意识丧失数分钟而入院。患者无心脏病、胸痛、气喘或心悸史。几年来,患者一直服用劳拉西泮(lorazepam)1mg,4次/d及普萘洛尔40mg,2次/d以治疗焦虑。入院前2周,始用氟西汀20mg,1次/d以控制抑郁。入院时,患者的脉搏规律,为30次/min,皮肤温暖,充盈良好,血压为15.3/9.3kPa。心电图示完全性心脏传导阻滞,逸搏节律为30次/min。普萘洛尔和氟西汀被停用,临时埋入起搏导管。起初,患者仍要依赖于起搏器,但2d后,即恢复窦性心律,为60次/min。心电图显示完全性左束支传导阻滞,电轴左偏。随后,埋入永久性起搏器,无并发症,再次使用普萘洛尔,对传导无不良影响。
There are several reports that fluoxetine (antidepressant) interacts with lipophilic β-blockers to cause bradycardia and syncope. This article reports a male patient who, after taking fluoxetine and propranolol, caused complete heart block. Patient: Male, 53 years old, admitted to hospital for dizziness, discomfort, loss of consciousness for several minutes. Patient has no history of heart disease, chest pain, asthma or heart palpitations. For years, patients had been treated with lorazepam 1 mg, 4 times daily and propranolol 40 mg twice daily for anxiety. 2 weeks before admission, the beginning with fluoxetine 20mg, 1 / d to control depression. Admission, the patient’s pulse rate, 30 beats / min, the skin warm, well-filled, blood pressure of 15.3 / 9.3kPa. ECG showed complete heart block, escape rhythm of 30 beats / min. Propranolol and fluoxetine were discontinued and pacing catheters were temporarily embedded. Initially, the patient still had to rely on the pacemaker, but after 2 days, sinus rhythm was restored at 60 beats / min. ECG showed complete left bundle branch block, left axis deviation. Subsequently, a permanent pacemaker was embedded, without complications, and again with propranolol, without adverse effects on conduction.