静脉用胺碘酮后QT间期延长危险因素分析  

Analysis of risk factors for QT interval prolongation induced by intravenous amiodarone administration

作　　者：姚鑫宝[1] 林阳[1] 张晓星[2] 高绪霞[3] 周洋[1] 方振威[1] 石秀锦[1] 刘玉清[2] 娄莹[2] 田蕾[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所药事部,100029 [2]北京协和医学院中国医学科学院阜外心血管病医院卫生部心血管药物临床研究重点实验室 [3]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所全科医疗科,100029

出　　处：《心肺血管病杂志》2017年第1期10-13,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：“重大新药创制”科技重大专项《心血管创新药物临床研究技术平台建设》(2012ZX09303008-001)

摘　　要：目的:分析我院静脉用胺碘酮不良反应QT间期延长的可能影响因素,为临床更好发挥胺碘酮作用,减少不良反应提供依据。方法:回顾性分析我院2011年6月10日至2012年5月10日期间静脉用胺碘酮患者的临床资料,采用描述性研究方法分析我院静脉用胺碘酮患者的不良反应,然后根据是否用药后出现经心率校正的QT(QTc)间期延长将患者分为两组,QTc间期延长组(L-QTc)和QTc间期非延长组(N-QTc),采用单因素及多因素Logistic回归分析的方法分析患者用药后出现长QTc间期的可能危险因素。结果:静脉使用胺碘酮患者共计534例,其中419例为心脏术后发生快速性心律失常应用。去除胺碘酮应用后缺乏心电图的病例,最终纳入病例243例,应用胺碘酮后发生肝功能损害18例(7.4%),严重血压降低5例(2.1%),QTc间期延长62例(25.5%),静脉炎2例(0.8%),无心动过缓或房室传导阻滞的发生。经单因素和多因素Logistic逐步回归分析显示,手术后急性肾损伤是QTc间期延长的危险因素。结论:我院静脉用胺碘酮主要用于心脏手术后发生快速性心律失常的患者,QTc间期延长发生率较高,心脏术后急性肾损伤是QTc间期延长的独立危险因素。Objective： To determine the occurrence of amiodarone-induced side effects, and analyze risk factors for amiodarone-induced QTe interval （ QT interval corrected by heart rate ） prolongation. Methods ： Clinical data of 534 in-patients with intravenous amiodarone administration in our hospital from June 10,2011 through May 10, 2012 were analyzed retrospectively. According to whether or not the QTe interval prolonged after intravenous amiodarone administration, patients were divided into QTc interval prolongation group （L-QTc） and QTe interval non-prolongation group （N-QTc）, then demographic characteristics, medical history, operation, acute kidney injury following cardiac surgery, bonus dose, total dose of amiodarone during the first 24 hours, and types of arrhythmia were compared between two groups, using chi-square or t-student test first and multivariable logistic regression analysis finally. Results：After cases with incomplete ECG records before or after amiodarone administration were picked out, total 243 cases were analyzed. It revealed that 62 patients （25.5%） occurred QTc interval prolongation, 18 （5.62%） patients had liver injury, 5 patients （2. 1% ） appeared severe decreased blood pressure, and 2 （0. 8% ） patients got phlebitis, but nobody had allergic response, bradyarrhythmia or atrioventricular block. Muhivariable logistic regression analysis showed that acute kidney injury following cardiac surgery were an independent risk factor for QTc prolongation. Conclusion： Intravenous amiodarone used to be administrated in patients after cardiac surgery in our hospital. Intravenous amiodarone administration induced higher occurrence of QTc interval prolongation. Acute kidney injury following cardiac surgery is an independent risk factor for QTc prolongation.

关 键 词：静脉用胺碘酮 不良反应 QTC间期延长 急性肾损伤 

分 类 号：R54[医药卫生—心血管疾病]