临床药物治疗杂志
臨床藥物治療雜誌
림상약물치료잡지
CLINICAL MEDICATION JOURNAL
2014年
6期
31-36
,共6页
顾智淳%刘晓琰%李峥%潘忙忙%张在丽
顧智淳%劉曉琰%李崢%潘忙忙%張在麗
고지순%류효염%리쟁%반망망%장재려
胺碘酮%QTc间期%药品不良反应%尖端扭转性室速
胺碘酮%QTc間期%藥品不良反應%尖耑扭轉性室速
알전동%QTc간기%약품불량반응%첨단뉴전성실속
amiodarone%QTc interval%adverse drug reaction%torsades de pointes
目的：评价胺碘酮对我院房颤患者Q Tc间期的影响及其药品不良反应。方法：研究纳入2013年1月-2014年5月间上海交通大学医学院附属仁济医院房颤住院患者共l56例，记录患者一般资料及合用药物等信息，观察应用胺碘酮注射液或胺碘酮片剂后心率、Q T间期、Q Tc间期的变化，以及在胺碘酮用药期间是否发生与用药相关的不良反应。结果：用药后房颤患者的平均心率显著减慢(79.2±21.6)bpm比（72.9±13.1）bpm (P<0.01)，QT间期(386.5±45.7)ms比（415.8±53.1） ms (P<0.01)、QTc间期均显著延长(413.9±32.1)ms比（438.0±44.4）ms（P<0.01）。有16例患者用药后QTc>500ms，17例患者用药后QTc<500ms，但△QTc>50ms。共有22例患者合并使用一种或多种可延长QT间期的药物，包括氟哌噻吨美利曲辛片（10例），多塞平（7例），左氧氟沙星（6例）等。心动过缓、2型糖尿病、合用其他影响QT间期药物为延长QTc间期的因素(P<0.05)。44例患者使用胺碘酮注射液中有5例发生注射部位反应，未出现与胺碘酮相关的心律失常（包括尖端扭转性室速）。结论：胺碘酮应用后QT间期、QTc间期均不同程度延长，对于用药后QTc>500ms、△QTc>50ms或合并使用其他可延长QT间期药物的患者，需调整胺碘酮剂量并严密监测心电图，警惕恶性心律失常的发生。
目的：評價胺碘酮對我院房顫患者Q Tc間期的影響及其藥品不良反應。方法：研究納入2013年1月-2014年5月間上海交通大學醫學院附屬仁濟醫院房顫住院患者共l56例，記錄患者一般資料及閤用藥物等信息，觀察應用胺碘酮註射液或胺碘酮片劑後心率、Q T間期、Q Tc間期的變化，以及在胺碘酮用藥期間是否髮生與用藥相關的不良反應。結果：用藥後房顫患者的平均心率顯著減慢(79.2±21.6)bpm比（72.9±13.1）bpm (P<0.01)，QT間期(386.5±45.7)ms比（415.8±53.1） ms (P<0.01)、QTc間期均顯著延長(413.9±32.1)ms比（438.0±44.4）ms（P<0.01）。有16例患者用藥後QTc>500ms，17例患者用藥後QTc<500ms，但△QTc>50ms。共有22例患者閤併使用一種或多種可延長QT間期的藥物，包括氟哌噻噸美利麯辛片（10例），多塞平（7例），左氧氟沙星（6例）等。心動過緩、2型糖尿病、閤用其他影響QT間期藥物為延長QTc間期的因素(P<0.05)。44例患者使用胺碘酮註射液中有5例髮生註射部位反應，未齣現與胺碘酮相關的心律失常（包括尖耑扭轉性室速）。結論：胺碘酮應用後QT間期、QTc間期均不同程度延長，對于用藥後QTc>500ms、△QTc>50ms或閤併使用其他可延長QT間期藥物的患者，需調整胺碘酮劑量併嚴密鑑測心電圖，警惕噁性心律失常的髮生。
목적：평개알전동대아원방전환자Q Tc간기적영향급기약품불량반응。방법：연구납입2013년1월-2014년5월간상해교통대학의학원부속인제의원방전주원환자공l56례，기록환자일반자료급합용약물등신식，관찰응용알전동주사액혹알전동편제후심솔、Q T간기、Q Tc간기적변화，이급재알전동용약기간시부발생여용약상관적불량반응。결과：용약후방전환자적평균심솔현저감만(79.2±21.6)bpm비（72.9±13.1）bpm (P<0.01)，QT간기(386.5±45.7)ms비（415.8±53.1） ms (P<0.01)、QTc간기균현저연장(413.9±32.1)ms비（438.0±44.4）ms（P<0.01）。유16례환자용약후QTc>500ms，17례환자용약후QTc<500ms，단△QTc>50ms。공유22례환자합병사용일충혹다충가연장QT간기적약물，포괄불고새둔미리곡신편（10례），다새평（7례），좌양불사성（6례）등。심동과완、2형당뇨병、합용기타영향QT간기약물위연장QTc간기적인소(P<0.05)。44례환자사용알전동주사액중유5례발생주사부위반응，미출현여알전동상관적심률실상（포괄첨단뉴전성실속）。결론：알전동응용후QT간기、QTc간기균불동정도연장，대우용약후QTc>500ms、△QTc>50ms혹합병사용기타가연장QT간기약물적환자，수조정알전동제량병엄밀감측심전도，경척악성심률실상적발생。
Objective: To evaluate the impact on QTc interval and adverse drug reaction of amiodarone in patients with non-valvular atrial fibrillation. Methods: 156 patients admitted into our hospital from Jan 2013 to May 2014 were included in this study. General information and medication during the admission were recorded and changes in heart rate, QT intervals and QTc intervals before and after the administration of amiodarone injection or tablets were measured. The relevant drug adverse reactions were monitored during the usage of amiodarone. Results:The average heart rate was slowed signiifcantly (79.2±21.6 bpm vs72.9±13.1 bpm, P<0.01), QT interval was prolonged signiifcantly (386.5±45.7 ms vs 415.8±53.1 ms, P<0.01) as well as QTc interval (413.9±32.1 ms vs 438.0±44.4 ms, P<0.01) after administration of amiodarone compared with the baseline. 16 patients emerged QTc>500ms, and 17 patients emerged △ QTc>50ms with QTc<500ms after administration of amiodarone. There were 22 patients with concomitant use of other drugs possibly inducing QT interval prolongation, including lfupentixol and melitracen (10 cases), doxepin (7 cases), levolfoxacin (6 cases) etc. There are also other factors which can induce prolongation of QTc interval, including bradycardia, diabetes mel itus and concomitant use of other drugs prolonging QT interval (P<0.05). Among 44 cases using amiodarone injection, there were 5 cases developing injection site reaction without amiodarone-related arrhythmia. Conclusion:QT interval and QTc interval were prolonged signiifcantly after administration of amiodarone. Dosage adjustion and EKG monitoring should be considered to avoid malignant ventricular arrhythmia in patients emerging QTc>500ms or △QTc>50ms after amiodarone usage, and concomitant use of other drugs possibly inducing QT interval prolongation may increase the risk of torsades de pointes.
