抗膽鹼類物質中毒

抗膽鹼類藥毒物的毒性，可以分為中樞和週邊的作用，對中樞影響有譫妄、幻覺、躁動以及抽搐。對週邊的影響則包含心跳加速、心律不整、皮膚潮紅、皮膚及黏膜乾燥、尿滯留、腸胃蠕動減緩。許多臨床藥物及有毒植物都會引起抗膽鹼中毒症候群。茄科植物中有毒的種類最多，是有毒植物中最重要的科之一，主要是由於它們含有不同種類的有毒生物鹼。在治療大部分抗膽鹼類藥物質中毒的患者時，針對躁動的患者給予支持性療法、活性碳腸胃道去污以及使用benzodiazepine類藥物來治療即可。解毒劑為毒扁豆素(Physostigmine)，毒扁豆素可以通過血腦障壁，用於治療嚴重之中樞抗乙醯膽鹼症狀，成人使用劑量1-2mg，兒童劑量0.02mg/kg（最大單一劑量0.5mg），以緩慢靜脈注射。臨床醫師必須由詳細病史詢問及心電圖的監測（觀察有無QRS期間及QT節段的延長），來辨識中毒症狀是否由環狀抗鬱劑及Phenothiazines類藥物所造成。因為以上兩類藥物除了抗膽鹼作用之外更具有心臟毒性，會引起致命性心律不整。

關鍵字

抗膽鹼類藥毒物中毒；抗膽鹼症候群；茄科植物；毒扁豆素；環狀抗鬱劑

並列摘要

Anticholinergic poisoning is manifested by a constellation of both peripheral and central signs and symptoms. Central anticholinergic toxicity is characterized by delirium, hallucinations, and seizures. Peripheral anticholinergic toxicity is characterized by tachycardia, dry skin and mucous membranes, urinary retention, decreased bowel sounds, and hyperthermia. Many pharmaceutical preparations, as well as various plant species may cause anticholinergic properties. In most cases of antocholinergic toxicity, supportive care, activated charcoal for gastric decontamination, and benzodiazepines for agitation are adequate therapies. Physostigmine can be used as antidote for severe central anticholinergic toxicity. The usual dose is 0.02 mg/kg (maximum 0.5 mg) infused over at least 5 minutes. Cyclic Antidepressants, certain phenothiazines toxicity should be excluded by history and electrocardiogram prior to the administration of physostigmine. A prolonged QRS interval duration with subsequent prolonged QTC may result, and severe cardiac dysrhythmias can occur.

並列關鍵字

anticholinergic poisoning ； anticholinergic syndrome ； Solanaceae ； physostigmine ； cyclic antidepressants

國際替代計量

抗膽鹼類物質中毒

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