左西孟旦致尖端扭转型室性心动过速和阿斯综合征  

Torsades de Pointes and Aspen syndrome due to levosimendan

作　　者：孙玥 刘佳[2] 廖清池[3] Sun Yue;Liu Jia;Liao Qingchi(Department of Pharmacy,the Affiliated Hospital of Yangzhou University,Jiangsu Province,Yangzhou 225001,China;Department of Pharmacy,Northern Jiangsu People′s Hospital,Jiangsu Province,Yangzhou 225001,China;Department of Cardiology,Northern Jiangsu People′s Hospital,Jiangsu Province,Yangzhou 225001,China)

机构地区：[1]扬州大学附属医院药剂科,225001 [2]江苏省苏北人民医院药学部,扬州225001 [3]江苏省苏北人民医院心内科,扬州225001

出　　处：《药物不良反应杂志》2020年第4期266-267,共2页Adverse Drug Reactions Journal

摘　　要：1例72岁女性患者因心力衰竭接受静脉注射呋塞米注射液,口服美托洛尔缓释片、呋塞米片、螺内酯片、地高辛片和单硝酸异山梨酯缓释片治疗。因心力衰竭症状未改善,加用左西孟旦12.5 mg入0.9%氯化钠注射液45 ml,以1.5 ml/h速度持续静脉泵入。静脉泵入左西孟旦20 h时,患者突然出现意识丧失,呼之不应,瞳孔散大。心电监护示心率200次/min,QT间期延长,QTc间期520 ms;血钾3.02 mmol/L。诊断:尖端扭转型室性心动过速,阿斯综合征。考虑与左西孟旦有关。立即停用该药,给予胸外心脏按压、电除颤和补钾治疗。4 d后复查,血钾4.60 mmol/L,心电图检查示心率80次/min,QTc间期450 ms。A 72-year-old female patient received intravenous injection of furosemide injection and oral metoprolol succinate sustained-release tablets,furosemide tablets,spironolactone tablets,digoxin tablets,and isosorbide mononitrate sustained release tablets for heart failure.Continuous intravenous pumping of levosimendan 12.5 mg dissolved in 0.9%sodium chloride 45 ml at a speed of 1.5 ml/h was additionally given because of her unimproved symptoms of heart failure.After 20 hours of intravenous pumping,the patient developed unconsciousness,no response to voice stimuli,and bilateral mydriasis suddenly.The electrocardiogram monitoring showed heart rate 200 beats per minute,prolonged QT interval,and QTc period 520 ms.The laboratory tests showed serum potassium 3.02 mmol/L.She was diagnosis as Torsades de Pointes and Aspen syndrome,which were considered to be related with levosimendan.Levosimendan was stopped immediately.The treatments such as closed-chest cardiac massage,electric defibrillation,and potassium supplementation were given.Four days later,the reexamining results showed her serum potassium 4.60 mmol/L,heart rate 80 beats per minute,and QTc period 450 ms.

关 键 词：扭转性室速 低钾血症 左西孟旦 

分 类 号：R541[医药卫生—心血管疾病]