三环类抗抑郁药药物过量

三环类抗抑郁药药物过量（英语：Tricyclic antidepressant overdose），系指过度摄取三环类抗抑郁药（英语：tricyclic antidepressant，简称 TCA）类型药物而中毒。症状有体温过高、视线模糊、瞳孔放大、嗜睡、意识错乱、癫痫发作、心跳过速及心搏停止^[1]。通常症状会在用药过度后六小时内出现，如果没有，应该就不会有症状^[2]。

会发生服用此种药物过量的原因可能为意外或是刻意自杀^[2]，中毒的剂量高低则随不同药物而有差异^[2]。大多数的三环类抗抑郁药物如服用不超过每公斤5毫克，通常并不会中毒；但地昔帕明（英语：desipramine）、去甲替林与曲米帕明（英语：trimipramine）则属例外，这3种药物只需服用达每公斤2.5毫克即可能会中毒^[2]。因此对于幼童而言，就算只误食1、2粒此种药物也可能会造成生命危险^[3]。若怀疑患者有服用此种药物过量的情形时，应为其安装心电图以利监测诊断^[2]。

治疗药物中毒时，一般会推荐采用活性碳^[1]，不应强行将患者催吐^[2]，患者的QRS波群若相对较广（> 100 ms），推荐采用碳酸氢钠^[2]；若患者癫痫发作，通常会给予的是苯二氮䓬类药物^[2]。若患者有低血压，会采用静脉注射和去甲基肾上腺素^[1]，或许也会采用脂肪乳剂静脉输液（英语：Intravenous lipid emulsion）^[4]。

2000年代初期，三环类抗抑郁药物是常见的药物中毒原因之一^[1]，2004年，在美国就有12,000宗以上的病例^[2]；在英国，平均一年有270宗案例致死^[1]。第一宗三环类抗抑郁药药物过量病例出现于1959年^[1]。

参考文献

^ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 Kerr G, McGuffie A, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J. 2001, 18 (4): 236–41. PMC 1725608  . PMID 11435353. doi:10.1136/emj.18.4.236.
^ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 ^2.6 ^2.7 ^2.8 Woolf, Alan D.; Erdman, Andrew R.; Nelson, Lewis S.; Caravati, E. Martin; Cobaugh, Daniel J.; Booze, Lisa L.; Wax, Paul M.; Manoguerra, Anthony S.; Scharman, Elizabeth J.; Olson, Kent R.; Chyka, Peter A.; Christianson, Gwenn; Troutman, William G.; American Association of Poison Control Centers. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology. 1 January 2007, 45 (3): 203–233. ISSN 1556-3650. PMID 17453872. doi:10.1080/15563650701226192.
^ Rosenbaum T, Kou M. Are one or two dangerous? Tricyclic antidepressant exposure in toddlers. J Emerg Med. 2005, 28 (2): 169–74. PMID 15707813. doi:10.1016/j.jemermed.2004.08.018.
^ Cao, Dazhe; Heard, Kennon; Foran, Mark; Koyfman, Alex. Intravenous lipid emulsion in the emergency department: a systematic review of recent literature. The Journal of Emergency Medicine. 1 March 2015, 48 (3): 387–397. ISSN 0736-4679. PMID 25534900. doi:10.1016/j.jemermed.2014.10.009.

[Kerr2001-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 Kerr G, McGuffie A, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J. 2001, 18 (4): 236–41. PMC 1725608  . PMID 11435353. doi:10.1136/emj.18.4.236.

[Wo2007-2] 2.0 ^2.1 ^2.2 ^2.3 ^2.4 ^2.5 ^2.6 ^2.7 ^2.8 Woolf, Alan D.; Erdman, Andrew R.; Nelson, Lewis S.; Caravati, E. Martin; Cobaugh, Daniel J.; Booze, Lisa L.; Wax, Paul M.; Manoguerra, Anthony S.; Scharman, Elizabeth J.; Olson, Kent R.; Chyka, Peter A.; Christianson, Gwenn; Troutman, William G.; American Association of Poison Control Centers. Tricyclic antidepressant poisoning: an evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology. 1 January 2007, 45 (3): 203–233. ISSN 1556-3650. PMID 17453872. doi:10.1080/15563650701226192.

[Ros2005-3] Rosenbaum T, Kou M. Are one or two dangerous? Tricyclic antidepressant exposure in toddlers. J Emerg Med. 2005, 28 (2): 169–74. PMID 15707813. doi:10.1016/j.jemermed.2004.08.018.

[Daz2015-4] Cao, Dazhe; Heard, Kennon; Foran, Mark; Koyfman, Alex. Intravenous lipid emulsion in the emergency department: a systematic review of recent literature. The Journal of Emergency Medicine. 1 March 2015, 48 (3): 387–397. ISSN 0736-4679. PMID 25534900. doi:10.1016/j.jemermed.2014.10.009.

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