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我院常用喹诺酮类药物的心脏不良反应分析
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| 篇名： | 我院常用喹诺酮类药物的心脏不良反应分析 |
| TITLE： | |
| 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3 288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（P＞0.05）外，与其他临床表现的差异均有统计学意义（P＜0.05）。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（P＜0.05）；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（P＜0.05）。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（P＜0.01）；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（P＜0.05）。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 ADR induced by quinolones， and to provide reference for clinical treatment. METHODS： Three thousaud two hundred and eighty-eight 8 patients receiving common quinolones were selected from clinical departments in Zhengzhou Central Hospital of Zhengzhou University during Mar. 2012-Mar. 2016. Retrospective analysis was conducted in terms of patients’ age and gender， clinical departments， main clinical manifestations， route of administration， underlying disease， drug combination. The reasons for cardiac ADR were analyzed. RESULTS： Among 3 288 patients， there were 34 patients （1.03％） with cardiac ADR. Among them， the incidence of cardiac ADR in patients over 50 years old was as high as 76.47％； patients with cardiac ADR were mainly in the respiration department， gastroenterology department and urology department， accounting for 76.47％； most of patients were from gastroenterology department （29.41％）. In cardiac ADR， the main clinical manifestations were QTc interval prolongation torsades de poiutes （TdP） and TdP， accounting for 58.82％. Among them， patients with QTc interval prolongation TdP occupied the highest proportion， there was no statistical significance compared to TdP （P＞0.05）； there was statistical significance in the difference with other clinical manifestations （P＜0.05）. Among commonly used quinolones， levofloxacin （32.35％） and ciprofloxacin （41.18％） caused large proportion of cardiac ADR， there was statistical significance compared to norfloxacin， moxifloxacin and other quinolones （P＜0.05）. The proportion of cardiac ADR induced by intravenous dripping （91.18％） was much higher than oral administration （8.82％）， with statistical significance （P＜0.05）. Among patients with cardiac ADR， the patients with underlying disease （94.12％） and drug combination （91.18％） occupied the higher proportion， there was statistical significance compared to the patients without underlying disease and drug combination （P＜0.01）. Among drug combination， the patients receiving amiodarone （29.41％） and salbutamol （20.59％） occupied the large proportion， there was statistical significance compared to other types of drug combination （P＜0.05）. CONCLUSIONS： Cardiac ADR induced by quinolones in our hospital mostly occurs in respiration department， gastroenterology department and urology department， and mainly manifests as QTc interval prolongation TdP and TdP. The incidence of cardiac ADR may be greatly increased in elderly patients， patients with underlying diseases， and drug combination as well as intravenous infusion. Therefore， clinicians should select suitable quinolones， and make reasonable individualized dosage regimen. |
| 期刊： | 2017年第28卷第5期 |
| 作者： | 刘芳，马香芹，杨丽娜，曹亚卓，张冠磊 |
| AUTHORS： | LIU Fang，MA Xiangqin，YANG Lina，CAO Yazhuo，ZHANG Guanlei |
| 关键字： | 喹诺酮；心脏；不良反应 |
| KEYWORDS： | Quinolone； Cardiac； ADR |
| 阅读数： | 428 次 |
| 本月下载数： | 6 次 |
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