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注意缺陷与多动障碍患者接受药物治疗时的心脏评估

Author
Stuart Berger, MD
Section Editor
John K Triedman, MD
Deputy Editor
Carrie Armsby, MD, MPH
Translators
贾飞勇, 副主任医师，副教授

引言

在使用兴奋性药物治疗注意缺陷与多动障碍(attention deficit hyperactivity disorder, ADHD)的患者中意外猝死(sudden unexpected deaths, SUD)的报道，已引发人们对精神药物安全性的关注。特别是，兴奋性药物是否会增加心血管(cardiovascular, CV)不良事件风险的问题，已引发了下述争论：患者开始药物治疗ADHD之前，是否需要通过适当评估来识别出尚未诊断的先天性心脏病(congenital heart disease, CHD)和/或心律失常风险。

本文将总结ADHD患者接受兴奋性药物时的心脏性猝死(sudden cardiac death, SCD)风险及针对这些患者的心脏评估。ADHD的药物治疗将单独作更详细讨论。 (参见“儿童和青少年注意力缺乏多动障碍治疗药物的药理学”)

意外猝死的风险

ADHD是一种常见的儿童期疾病，在全部学龄期儿童中的发生率高达8%-10%。兴奋性药物包括哌甲酯(Ritalin、Methylin、Concerta、Focalin、Metadate)、右苯丙胺(Dexedrine)和苯丙胺混合盐(如，Adderall)，这些药物均可有效改善此类患者的行为问题。 (参见“儿童和青少年注意缺陷多动障碍：流行病学与发病机制”，关于‘流行病学’一节和“儿童和青少年注意缺陷多动障碍：药物治疗”，关于‘兴奋剂vs其他药物’一节)

有关接受兴奋性药物治疗的儿童意外死亡的报道，引起了人们对这些药物会增加心血管不良事件(包括SUD)风险的关注[1-3]。然而，大规模队列研究并未显示，与一般儿科人群相比，接受兴奋性药物治疗的儿童严重不良心血管事件的风险会增加，如下文章节讨论所示。

无心脏疾病的儿童 — 现有的证据显示，与一般儿科人群相比，无心脏疾病儿童接受兴奋性药物治疗后心血管事件的风险似乎没有增加。因此，我们遵循美国心脏协会(American Heart Association, AHA)和美国儿科学会(American Academy of Pediatrics, AAP)的推荐，即：根据综合的以心血管为重点的病史询问和体格检查，如果某一ADHD儿童没有心脏疾病的证据，则可开始兴奋性药物治疗。 (参见下文‘推荐的方法’)

             

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-14.
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