莫西沙星对肺心病患者QT离散度的影响

Effects of moxifloxacin on QT dispersion of cor pulmonale

目的研究喹诺酮类抗生素莫西沙星用于肺心病心功能失代偿期抗感染治疗时对其QT离散度（QTd）的影响，为肺心病抗感染治疗提供进一步研究资料。方法将87例临床病例分为两组：肺心病观察组（n=60）和非肺心病对照组（n=27），记录其QTd及校正的QT离散度（QTcd），进行统计分析。再将上述病例分为三组，肺心病心功能失代偿期患者使用莫西沙星抗感染治疗组（n=29），肺心病心功能失代偿期患者使用8一内酰胺类抗生素（哌拉西林／头孢哌酮）抗感染治疗（n=31），无肺心疾患的感染患者使用莫西沙星抗感染治疗（n=27），记录其用药前、用药2h和用药48h的QTd及QTcd，并进行统计分析。结果60例肺心病心功能失代偿期患者和27例非肺心病心功能失代偿期患者QTd和QTcd比较差异有显著统计学意义（P〈O．01）。29例肺心病心功能失代偿期患者使用莫西沙星抗感染治疗时，用药2h和用药48h与用药前QTd和QTcd比较差异有显著统计学意义（P〈0．01）；用药48h与用药2hQTd和QTcd比较差异有统计学意义（P〈0．05）。31例肺心病心功能失代偿期患者使用伊内酰胺类抗生素抗感染治疗时，用药2h和用药48h与用药前QTd和QTcd比较差异无统计学意义（P〉0．05）。27例无肺心疾患的感染患者使用莫西沙星抗感染治疗时，用药2h与用药前QTd和QTcd比较差异无统计学意义（P〉0．05）；用药48h与用药前QTd和QTcd比较差异有统计学意义（P〈0．05）。结论①肺心病心功能失代偿期患者QTd、QTcd是增大延长的，往往QTd越大，预后越差。②莫西沙星具有增加QTd的作用，当有肺心病等潜在QT间期延长的危险因素时，更容易使其QTd增大延长。

Objective To investigate the effects of moxifloxacin on QT dispersion （QTd） of cor pulmonale, and to provide further evidences for anti-infection treatment of cor pulmonale. Methods 87 patients were divided into two groups： cor pulmonale group （ n =60） and non-cor pulmonale group （ n = 27）. Statistical analysis was carried out to study the QTd and QTcd numerical value of all patients. All patients were subsequently divided into three groups：cot pulmonale treated with moxifloxacin （ n = 29）, cor pulmonale treated with β-lactam antibiotics （Piperacillin/Cefoperazone） （ n = 31）, non-cot pulmonale treated with moxifloxacin （ n =27）. QTd and QTcd numerical value were tested before,two hours after and 48 hours after medication and were analyzed statistically. Results The difference between QTd and QTcd prolongation of cor pulmonale patients and non-cot putmonale patients was statistically significant （ P〈0.01）. In cor pulmonale patients treated with moxifloxaein, QTd and QTcd prolongation were conspicuous after two or 48 hours compared with that before medication （ P〈0.01）. Meanwhile, 48 hours also prolonged QTd and QTcd than two hours （ P〈0.05）. In cor pulmonale patients treated with β-lactam antibiotics, QTd and QTcd were not prolonged after medication when compared with that before medication （ P 〈0.05）. However, in the non-cor pulmonale patients treated with moxifloxacin, QTd andQTcd prolongation were not significant after two hours （ P 〈0.05）, but significant after 48 hours （ P〈0.05）. Conclusions QTd and QTcd prolongation are significant during cot pulmonale decompensation and are negatively correlated with the prognosis of cor pulmonale. Moxifloxacin could prolong QTd especially in patients with cor pulmonale deeompensation.