药源性QT间期/QTc延长和尖端扭转型室性心动过速的风险及预警措施的研究进展

Research advances in risk and forewarning measures of drug-induced QT interval or QTc prolongation and torsade de pointes

许多广泛使用的药物都可能导致QT间期/QTc延长,继而引起尖端扭转型室性心动过速(torsade de pointes,TdP)等心律失常,后者可能会进一步恶化为心室颤动,甚至造成心脏性猝死。因此,为了预防和降低药源性QT间期延长和TdP的风险,对危险因素的发现、预警和纠正至关重要。近年来,临床已开始应用决策支持系统等预警策略,通过识别多种风险因素预测QT间期/QTc延长和警示TdP高风险人群。本文总结了可引起长QT间期和TdP风险的药物及相关危险因素,并归纳现有的预警措施,期望为暴露于相关风险的患者管理提供参考。

Many commonly used medications have the potential to induce QT interval or QTc prolongation,subsequently leading to torsade de pointes(TdP)and other arhythmias,which may further deteriorate into ventricular fibrillation and even sudden cardiac death.Therefore,it is crucial to make identification,early warning and correction of risk factors in order to prevent and reduce the risk of drug-induced QT interval prolongation and TdP.In recent years,clinical decision support systems and other early warning strategies have been widely employed for predicting QT interval or QTc prolongation by identifying various risk factors,and warning to the high-risk population susceptible to TdP.This article summarizes drugs and related risk factors that contribute to prolonged QT interval and TdP risk,as well as concludes the existing warning measures,aiming to offer guidance for managing patients exposed to the related risks.