克拉霉素致室性心律失常的观察及部分机制探讨  

The study of ventricular arrhythmias caused by the clarithromycin

作　　者：王冠[1] 白融[2] 王金丽[1] 阮磊[1] 吴晓芬[1] 全小庆[1] 张存泰[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院综合科,湖北武汉430030 [2]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国心脏起搏与心电生理杂志》2017年第3期247-250,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨克拉霉素致室性心律失常的机制。方法 30只健康新西兰长耳兔随机分为对照组、常规剂量组(克拉霉素1倍血药浓度)和大剂量组(克拉霉素10倍血药浓度)组,每组各10只制作兔左室楔形心肌块模型。采用浮置玻璃微电极法同步记录各组内、外膜下心肌动作电位和容积心电图,观察在基础周长为2 000 ms电刺激情况下,灌流过程中QT间期、跨室壁离散度(TDR)和T波顶点到终点距离(T_(p-e))及致心律失常危险度。结果相比对照组,常规剂量组的QT间期、TDR、T_(p-e)和致心律失常危险度未见差异(P>0.05);相比其他两组,大剂量组QT间期、TDR和T_(p-e)明显延长(P<0.05),致心律失常危险度明显增大(5±3.27vs 0,0vs 0,P<0.05)。结论慢心率下,正常血药浓度克拉霉素致室性心律失常可能性较低,过高血药浓度克拉霉素易诱发尖端扭转性室性心律失常。Objective To explore the mechanism of ventricular arrhythmias induced by clarithromycin. Method Thirty arterially perfused rabbit left ventricular wedge preparations were randomly divided into control group （per- fused with tyrode＇s solution, n = 10）, conventional dose group （perfused with tyroders solution which contained cla- rithromycin of normal plasma concentration, n=10）, large dose group（perfused with tyrodeJs solution which con- tained clarithromycin of 10 times of normal plasma concentration, n = 10） and given an electric stimulation with a basic cycle length （BCL） of 2 000 ins. The floating glass rnicroelectrodes were utilized to simultaneously record trans-mural ECG and action potentials from both endocardium and epicardium. The changes of QT interval, trans- mural repolarization dispersion（TDR）,T wave peak to T wave end （Tp-e） and Tve/QT were recorded. Each group was scored quantitatively for its relative potential for arrhythmias by measuring QT interval dispersion for repolar- ization. Results ONo significant differences of the QT interval, the TDR, the Tp_o, the Tp.e/QT and the relative potential for arrhythmias were found between the control group and conventional dose group（P〉0.05 for each pa- rameter） ;②Compared with control group and conventional dose group, the QT interval, the TDR, the Tp-e, and the Tp-e/QT were significantly increased in large dose group（P〈0.05 for each parameter）and the relative potential for arrhythmias was also higher in large dose group（5±3.27 vs 0, 0vs 0, P〈0.05）. Conclusion The risk of ven- tricular arrhythmias induced by the clarithromycin in bradycardic condition is low under normal plasma drug concen- tration.Clarithromycin of excessive plasma concentrations is the trigger factor of ventricular arrhythmias in bradycardiccondition.

关 键 词：心血管病学 克拉霉素 室性心律失常 早后除极 尖端扭转型室性心动过速 

分 类 号：R541.7[医药卫生—心血管疾病]