塩酸ピルジカイニド（サンリズム®）大量服用によるインセサント型心室頻拍の救命例

A Case of Survival from Incessant Ventricular Tachycardia Caused by an Excess Dose of Pilsicainide Hydrochloride (Sunrythm®)

　27歳，男性．来院3カ月前にうつ病を疑われた患者で，1994年8月2日自殺企図にて塩酸ピルジカイニド（サンリズム^®）を15錠服用し，救急車にて来院，来院時軽度意識混濁，血圧は触診で収縮期60mmHg．血液検査所見では白血球の軽度上昇，軽度の肝障害を認め，心電図ではインセサント型心室頻拍を認めた．サンリズム大量服用による急性中毒と診断．2lの胃洗浄ののち，右室の高頻度ペーシングを施行し，洞調律に戻した．経時的に観察した塩酸ピルジカイニド血漿中濃度から，患者体内に吸収された塩酸ピルジカイニドは内服量の約49％であり，胃洗浄が塩酸ピルジカイニド血漿中濃度上昇を抑制するうえで有効であったと考えられた．また，同時に施行した心電図では延長したPQ間隔，QRS間隔が経時的に正常化，これらは塩酸ピルジカイニド血漿中濃度と正の相関を示し，T波は一定で不応期に影響を与えず，塩酸ピルジカイニドのヒトにおける電気生理的作用が実証された．

A 29-year-old man. who had been suspected to be a depressive three months before coming to our hospital, swallowed 750 mg of pilsica inide hydrochloride (Sunrythm^®) with suicidal intent. His consciousness was slightly turbid and his systolic blood pressure was 60 mmHg at the time of his admission by an ambulance. Slightly high white blood cell count and abnormal values indicative of liver damage were found in laboratory examination. and incessant ventricular tachycardia was found in the electrocardiogram. Since he was diagnosed as acute intoxication due to an excess dose of pilsicainide, gastric lavage was performed with 2 L of water associated with overdrivepacing at his right ventricle. Incessant ventricular tachycardia disappeared and returned to normal sinus rhythm in response to the gradual lowering of the pacing rates. Gastric lavage in the acute phase was assessed to be effective for prevention of further elevation of plasma pilsicainide level since the amount of pilsicainide absorbed was 49% of the amount he had taken. which was estimated from its plasma level. Prolonged PQ and QRS returned to normal in accord with decrease in the plasma pilsicainide level brought about by fluid loading. T wave was immutable, signifying that the refractory period was over. These results indicate that the toxic effect of pilsicainide shown in this patient was an in vivo reflection of its electrophysiological action.