伊布利特致尖端扭转型室性心动过速的文献分析
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摘要
目的:探讨伊布利特致尖端扭转型室性心动过速(TdP)的发生规律和特点,结合伊布利特药学监护经验,提出可行性建议和预防措施,为临床更好使用伊布利特及预防TdP提供参考。方法:检索1990年1月~2017年4月国内外文献报道的伊布利特致TdP个例,提取患者的性别、年龄、原患疾病、用药剂量、推注时间、TdP发生时间、用药前后血钾、QTc、ECG监测、合并疾病、处置用药及方法、转复结果等信息进行统计分析,并进行关联性评价。结果:共检索到9例报道,所有患者经过停药、电复律、补钾、补镁等治疗后,转为窦性心律。结论:临床处方时要特别关注高龄、女性、QTc延长、低钾、器质性心脏病、心衰史的患者;与说明书不符的给药间隔、推注时间或速度,TdP发生时间明显不同,提示临床药师应加强对伊布利特的推注时间、速度、给药间隔及血药浓度的药学监护,严格按说明书给药。
Objective: To analyze the general patterns and characteristics of torsade de pointes( Tdp) associated with ibutilide and provide feasible suggestions and preventive measurements combined with the experience of pharmaceutical monitoring. Methods: The cases of Td P associated with ibutilide were retrieved from the literatures reported at home and abroad during January 1990 and April 2017,and the clinical data including gender,age,original diseases,dosage of drugs,injection time,Td P occurrence time,potassium,QTc and ECG monitoring before and after the medication,complications,treatment drugs and methods and conversion outcome were statistically analyzed. Results: A total of 9 cases were enrolled in the analysis. After the treatment with ibutilide withdrawal,electroversion and potassium and magnesium supplement,all the patients converted to sinus rhythm. Conclusion: Ibutilide must be prescribed very carefully in senile female patients complicated with extended QTc,low potassium,organic heart disease and heart failure. With dosing interval,injection time or injection speed not compatible with the specification,the occurrence of Td P is significantly different,suggesting that clinical pharmacists strengthen the monitoring of injection time,speed,dosing interval and blood concentration of ibutilide according to the instruction strictly.
Objective: To analyze the general patterns and characteristics of torsade de pointes( Tdp) associated with ibutilide and provide feasible suggestions and preventive measurements combined with the experience of pharmaceutical monitoring. Methods: The cases of Td P associated with ibutilide were retrieved from the literatures reported at home and abroad during January 1990 and April 2017,and the clinical data including gender,age,original diseases,dosage of drugs,injection time,Td P occurrence time,potassium,QTc and ECG monitoring before and after the medication,complications,treatment drugs and methods and conversion outcome were statistically analyzed. Results: A total of 9 cases were enrolled in the analysis. After the treatment with ibutilide withdrawal,electroversion and potassium and magnesium supplement,all the patients converted to sinus rhythm. Conclusion: Ibutilide must be prescribed very carefully in senile female patients complicated with extended QTc,low potassium,organic heart disease and heart failure. With dosing interval,injection time or injection speed not compatible with the specification,the occurrence of Td P is significantly different,suggesting that clinical pharmacists strengthen the monitoring of injection time,speed,dosing interval and blood concentration of ibutilide according to the instruction strictly.
引文
1楚建民,张澍.抗心律失常新药——Ibutilide[J].中华心律失常学杂志,2002,6(1):60-62
2 Kowey PR,Vander Lugt JT,Luderer JR.Safety and risk/benefit analysis of ibutilide for acute conversion of atrial fibrillation/flutter[J].Am J Cardiol,1996,78(8A):46-52
3 Harg P,Madsen S.Severe ibutilide-induced arrhythmia in patients with heart failure[J].Tidsskr Nor Laegeforen,2001,121(24):2834-2835
4 敬锐,林文华.ICD自动转复伊布利特致Td P一例报告[J].天津医药,2013,41(7):717
5 李银,黎敬锋.伊布利特致尖端扭转型室性心动过速1例报告[J].吉林医学,2013,34(14):2844-2845
6 贾红莉.伊布利特致尖端扭转性室速一例[J].北方药学,2012,9(4):94
7 周立君,刘晶,李为民,伊布利特致尖端扭转性室性心动过速一例[J].中华心律失常学杂志,2006,10(4):307-308.
8 张鹏,李琼.伊布利特转复阵发性房颤致尖端扭转型室速一例[J].天津医药,2010,38(5):447-448
9 Ramesh M.Ibutilide-Induced Long QT Syndrome and Torsade de pointes[J].American Journal of Therapeutics,2002,9(6):527-529
10 Noranjo CA,Busto U,Sellers EM,et al.A methord for estimating the probability of adverse drug reactions[J].Clin Phamacol Ther,1981,30:239-245
11 Rodriguez,Kilborn MJ,Liu XK,et al.Drug-induced QT prolongation in women during the menstrual cycle[J].JAMA,2001,285(10):1322-1326
12 Cubeddu LX.QT prolongation and fatal arrhythmias:a review of clinical implications and effects of drugs[J].Am J Ther,2003,10(6):452-457
13 黄冬,李京波,魏盟.伊布利特抗心律失常作用的电生理学基础及其临床意义[J].中国新药与临床杂志,2005,24(11):910-912
14 Delle Karth G,Schillinger M,Geppert A,et al.Ibutilide for rapid conversion of atrial fibrillation or flutter in a mixed critically ill patient population[J].Wien Klin Wochenschr,2005,117(3):92-97
2 Kowey PR,Vander Lugt JT,Luderer JR.Safety and risk/benefit analysis of ibutilide for acute conversion of atrial fibrillation/flutter[J].Am J Cardiol,1996,78(8A):46-52
3 Harg P,Madsen S.Severe ibutilide-induced arrhythmia in patients with heart failure[J].Tidsskr Nor Laegeforen,2001,121(24):2834-2835
4 敬锐,林文华.ICD自动转复伊布利特致Td P一例报告[J].天津医药,2013,41(7):717
5 李银,黎敬锋.伊布利特致尖端扭转型室性心动过速1例报告[J].吉林医学,2013,34(14):2844-2845
6 贾红莉.伊布利特致尖端扭转性室速一例[J].北方药学,2012,9(4):94
7 周立君,刘晶,李为民,伊布利特致尖端扭转性室性心动过速一例[J].中华心律失常学杂志,2006,10(4):307-308.
8 张鹏,李琼.伊布利特转复阵发性房颤致尖端扭转型室速一例[J].天津医药,2010,38(5):447-448
9 Ramesh M.Ibutilide-Induced Long QT Syndrome and Torsade de pointes[J].American Journal of Therapeutics,2002,9(6):527-529
10 Noranjo CA,Busto U,Sellers EM,et al.A methord for estimating the probability of adverse drug reactions[J].Clin Phamacol Ther,1981,30:239-245
11 Rodriguez,Kilborn MJ,Liu XK,et al.Drug-induced QT prolongation in women during the menstrual cycle[J].JAMA,2001,285(10):1322-1326
12 Cubeddu LX.QT prolongation and fatal arrhythmias:a review of clinical implications and effects of drugs[J].Am J Ther,2003,10(6):452-457
13 黄冬,李京波,魏盟.伊布利特抗心律失常作用的电生理学基础及其临床意义[J].中国新药与临床杂志,2005,24(11):910-912
14 Delle Karth G,Schillinger M,Geppert A,et al.Ibutilide for rapid conversion of atrial fibrillation or flutter in a mixed critically ill patient population[J].Wien Klin Wochenschr,2005,117(3):92-97