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Yıl:2023; Cilt: 60; Sayı: 4>> Özet
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Nöropsikiyatri Arşivi; 2023;60(4):304-309
Opioid Kullanım Bozukluğu Tanılı Hastalarda, Yoksunluk Sırasında ve Sonrasındaki EKG Değişiklikleri
B Ünübol , F İzci , S İzci
Sağlık Bilimleri Üniversitesi, İstanbul
Amaç: Opioid yoksunluğu, opioid kullanım bozukluğunun en kritik komplikasyonlarından biridir. Bu çalışmada opioid yoksunluğunda ventriküler repolarizasyonun belirteçleri olan elektrokardiyografi (EKG) değişikliklerini hesaplayarak olası ventriküler aritmi ve ani kardiyak ölüm riskini incelemeyi amaçladık. Yöntem: Opioid yoksunluğu tanısı almış, dahil edilme ve dışlanma kriterlerini karşılayan toplam 90 hasta çalışmaya dahil edildi. Klinik Opiyat Yoksunluk Ölçeği (COWS) skoru beşin üzerinde ve Framingham kalp risk skoru %10’un altında olan hastaların 12 derivasyonlu EKG’de QT, QTc, TPe/QT ve TPE/QTc oranları ölçüldü. Bulgular: Hastaların kalp atım hızı, QT, QTc ve TPE/QT değerleri arasında yoksunluk sırasında (ilk) ve yoksunluk sonrasında (ikinci/kontrol) anlamlı fark bulundu (p<0,05). QT-Yoksunluk Değerinin Ortalaması (380,69±22,46), QT-kontrol Değerinin Ortalamasından (372,82±19,998); QTc yoksunluk Değerinin Ortalaması (435,41±16,22), QTc Kontrol Değerinin Ortalamasından (418,03±17,79); Ortalama Tpe yoksunluk Değeri, (81,62±6,009), Ortalama Tpe Kontrol Değerinden (79,93±5,524) ve Tpe/QT yoksunluk Değerinin Ortalaması (0,221±0,005), Tpe/QT Kontrol Değerinin Ortalamasından (0,213±0,004) anlamlı derecede farklı ve yüksekti (p<0,05). Sonuç: Çalışmamızın bulguları ani kardiyak ölüm ve ventriküler aritmi riskini gösteren elektrokardiyografik QT, QTc, Tpe ve Tpe/QTc değerlerinin opioid yoksunluğu sırasında anlamlı olarak yüksek olduğunu göstermektedir. Opioid yoksunluğu sırasında bağımlılık tedavisinin düzenlenmesine ek olarak, bireylerin kardiyak açıdan risk altında olabileceği göz önünde bulundurulmalı ve yoksunluk döneminde hasta kardiyak aritmi açısından izlenmelidir
Electrocardiographic Abnormalities During and After Withdrawal in Patients Diagnosed withOpioid Use Disorder
Introduction: Opioid withdrawal is one of the most critical complications of opioid use disorder. In this study, we aimed to examine the possible risk of ventricular arrhythmia and sudden cardiac death by calculating electrocardiography (ECG) changes, the markers of ventricular repolarization, in opioid withdrawal. Methods: A total of 90 patients diagnosed with opioid withdrawal who met the inclusion and exclusion criteria were included in the study. QT, QTc, TPe/QT, and TPe/QTc ratios of patients with a Clinical Opiate Withdrawal Scale (COWS) score higher than five and a Framingham heart risk score lower than 10% were measured in 12-lead ECG. Results: A significant difference was found between the patients’ heart rate, QT, QTc, and TPe/QT values during withdrawal (entry-first) and after withdrawal (second) (p<0.05). Mean QT First Value (380.69±22.46) was significantly different and higher than Mean QT Second Value (372.82±19.998); Mean QTc First Value (435.41±16.22) was significantly different and higher than Mean QTc Second Value (418.03±17.79); Mean Tpe First Value (81.62±6.009) was significantly different and higher than Mean Tpe Second Value (79.93±5.524); and the Mean Tpe/QT First Value (0.221±0.005) was significantly different and higher than the Mean Tpe/ QT Second Value (0.213±0.004) (p<0.05). Conclusion: The findings of our study show that electrocardiographic QT, QTc, Tpe and Tpe/QTc values, which indicate the risk of sudden cardiac death and ventricular arrhythmia, are significantly higher during opioid withdrawal. In addition to the regulation of addiction treatment during opioid withdrawal, it should be considered that individuals may be at cardiac risk, and the patient should be monitored for cardiac arrhythmia during the withdrawal period.

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