胺碘酮对房颤患者QTc间期的影响及安全性评价

Impact on QTc Interval and Safety Evaluation of Amiodarone for Non-Valvular Atrial Fibrillation Patients

目的:评价胺碘酮对我院房颤患者QTc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、QT间期、QTc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。

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.