氢氯噻嗪致肺水肿的文献病例分析  

Literature case analysis of pulmonary edema induced by hydrochlorothiazide

作　　者：唐威[1] 周良 许梦帆 朱建国[1] 谢诚[1] TANG Wei;ZHOU Liang;XU Mengfan;ZHU Jianguo;XIE Cheng(Department of Pharmacy,First Affiliated Hospital,Soochow University,Jiangsu Suzhou 215000,China;Department of Pharmacy,Xinyang Central Hospital,Henan Xinyang 464000,China)

机构地区：[1]苏州大学附属第一医院药学部,江苏苏州215000 [2]信阳市中心医院药学部,河南信阳464000

出　　处：《中国医院药学杂志》2024年第10期1184-1191,共8页Chinese Journal of Hospital Pharmacy

基　　金：国家临床重点专科(临床药学)建设项目(编号:国卫办医函[2018]292号)。

摘　　要：目的:分析氢氯噻嗪致肺水肿的发生情况及特点,为临床安全使用该药物提供参考。方法:检索建库至2023年6月收录在PubMed、Embase、Cochrane Library、中国知网、万方和维普期刊数据库有关氢氯噻嗪及其复方制剂导致肺水肿的病例报告类文献,并对患者信息,氢氯噻嗪的使用情况,肺水肿的发生时间、临床症状、处置及转归等进行描述性统计分析。结果:共纳入34篇文献共计41例患者,其中男性6例(14.6%)、女性35例(85.4%),≥60岁的有21例(51.2%)。所有患者均为单次服药后即出现肺水肿,其中33例(80.5%)发生在60 min内。所累及的系统器官和临床表现呈多样化,以呼吸困难、低血压和心动过速最为常见,分别有38例(92.7%)、27例(65.9%)和20例(48.8%)。经停药并予以呼吸支持、液体管理和糖皮质激素等治疗后36例(87.8%)患者转归良好。结论:肺水肿是氢氯噻嗪单次服用后短时间内即可发生的一种较为罕见的不良反应,且以女性、高龄患者多见。一旦患者出现呼吸困难和低血压等症状临床应考虑可能为其引起的肺水肿,应及时停药并予以呼吸支持等治疗。OBJECTIVE To explore the occurrences and characteristics of pulmonary edema induced by hydrochlorothiazide to provide references for clinical safe drug dosing. METHODS The case reports of pulmonary edema induced by hydrochlorothiazide were retrieved from the databases of PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP from inceptions until June 2023. Descriptive statistical analysis was conducted for patient profiles, dosing of hydrochlorothiazide, occurring time, clinical symptoms, treatments and outcomes of pulmonary edema. RESULTS A total of 41 cases from 34 articles were included. There were 6 males (14.6%), 35 females (85.4%) and 21 cases (51.2%) aged ≥60 year. Pulmonary edema occurred immediately after a single dose with 33 (80.5%) within 60 min. Systemic organs were involved. Clinical manifestations were diverse and dyspnea (n=38, 92.7%), hypotension (n=27, 65.9%) and tachycardia (n=20, 48.8%). Thirty-six patients (87.8%) had decent outcomes after discontinuation, respiratory supports, fluid management and glucocorticoids. CONCLUSION As a rare adverse reaction occurring immediately after a single dose of hydrochlorothiazide, pulmonary edema is more common in women and elders. It should be suspected for patients with dyspnea and hypotension. The prognosis is generally decent after timely discontinuation and adequate respiratory supports.

关 键 词：氢氯噻嗪 肺水肿 急性呼吸窘迫综合征 文献病例分析 

分 类 号：R979.9[医药卫生—药品]