我院常用喹诺酮类药物的心脏不良反应分析

发布时间：2018-06-04 04:47

本文选题：喹诺酮 + 心脏　；参考：《中国药房》2017年05期

【摘要】：目的:了解常用喹诺酮类药物心脏不良反应(ADR)的特点及原因,为临床治疗提供参考。方法:选取郑州大学附属郑州中心医院2012年3月-2016年3月接受常用喹诺酮类药物治疗的患者3288例,采用回顾性分析方法对其中发生心脏ADR的患者的年龄、性别、临床科室、主要临床表现、给药途径和基础疾病及合并用药情况进行统计,并分析发生心脏ADR的原因。结果:3 288例患者中,发生心脏ADR的患者有34例(1.03%),其中50岁以上患者占76.47%;发生心脏ADR患者主要分布在呼吸科、消化内科和泌尿科,共占76.47%,其中消化内科患者最多(29.41%)。心脏ADR的主要临床表现为QTc间期延长尖端扭转型室性心动过速(TdP)及TdP,合计比例为58.82%。其中QTc间期延长TdP的ADR患者比例最高,除了与TdP的差异无统计学意义(P0.05)外,与其他临床表现的差异均有统计学意义(P0.05)。常用的喹诺酮类药物中,左氧氟沙星(32.35%)和环丙沙星(41.18%)引发心脏ADR的比例较高,与诺氟沙星、莫西沙星及其他喹诺酮类药物比较,差异均有统计学意义(P0.05);并且静脉滴注引发心脏ADR的比例(91.18%)远高于口服给药(8.82%),差异有统计学意义(P0.05)。发生心脏ADR的患者中,存在基础疾病(94.12%)和合并用药(91.18%)的患者较高,与无基础疾病和无合并用药的患者比较,差异均有统计学意义(P0.01);合并用药中,服用胺碘酮(29.41%)和沙丁胺醇(20.59%)的患者较多,与其他合并用药种类比较,差异有统计学意义(P0.05)。结论:我院常用喹诺酮类药物的心脏ADR多发生于消化内科、呼吸科和泌尿科,常见QTc间期延长TdP和TdP等临床症状。老年患者、有基础疾病、合并用药及采用静脉滴注的给药方式,可能升高心脏ADR的发生率。因此临床医师应选择合适的喹诺酮类药物,并且制订合理的个体化用药方案。
[Abstract]:Objective: to investigate the characteristics and causes of cardiac adverse reactions (ADR) of commonly used quinolones in order to provide reference for clinical treatment. Methods: 3288 patients who were treated with commonly used quinolones in Zhengzhou Central Hospital affiliated to Zhengzhou University from March 2012 to March 2016 were selected. The age, sex and clinical department of patients with cardiac ADR were analyzed retrospectively. The main clinical manifestations, route of administration, basic diseases and combined use of drugs were analyzed, and the causes of cardiac ADR were analyzed. Results among the 3 288 cases, 34 cases had heart ADR, of which 76. 47% were over 50 years old, and 76. 47% were found in respiratory department, digestive department and urology department, among which 29.41% were found in digestive department. The main clinical manifestations of cardiac ADR were QTc interval prolongation of TdP and TDP, the total ratio was 58.82%. The proportion of ADR patients with QTc interval prolongation of TdP was the highest, except the difference with TdP was not statistically significant (P0.05), and there was significant difference with other clinical manifestations (P0.05). Among the commonly used quinolones, levofloxacin 32.35) and ciprofloxacin 41.18) caused ADR in the heart, compared with norfloxacin, moxifloxacin and other quinolones. The difference was statistically significant (P 0.05), and the ratio of ADR induced by intravenous drip was much higher than that by oral administration (P 0.05). Among the patients with cardiac ADR, the patients with basic disease (94.12) and the patients with combined medication (91.18) were higher than those with no underlying disease and without combined use of drugs (P 0.01). There were more patients taking amiodarone 29.41 and salbutamol 20.59). Conclusion: the cardiac ADR of the quinolones commonly used in our hospital occurs mostly in the departments of digestive, respiratory and urology, and the common clinical symptoms such as prolongation of TdP and TdP in QTc interval are common. The incidence of cardiac ADR may be increased in elderly patients with underlying diseases combined with medication and intravenous drip. Therefore, clinicians should select the appropriate quinolones and formulate a rational individualized regimen.
【作者单位】：河南医学高等专科学校基础医学部;郑州大学附属郑州中心医院病理科;河南科技大学第二附属医院呼吸内科;
【基金】：河南省基础与前沿技术研究计划项目(No.142300410469)
【分类号】：R978.1

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