某三级医院住院部药物致qt间期延长的前瞻性研究

A. Nejati, H. Singh, A. Naghdi
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摘要

目的:本研究旨在通过心电图数据、qt间期延长危险因素的预测因素和药物-药物相互作用来评估住院患者药物性qt间期延长。方法:这是一项在住院环境下进行的前瞻性观察性研究。采用设计前数据收集表收集110例患者的数据,对其进行为期6个月的评估。本研究考虑了至少一种延长qt间期药物的处方。收集的数据包括人口统计数据、用药后qt间期的平均变化、心电图数据和安全性分析数据。结果:共筛查患者110例。研究患者中以老年患者居多,占50.91%。主要合并症为糖尿病39例(35.45%),高血压36例(32.72%)。qt间期延长的发生率较高(46.45%)。延长组平均QTc为495±34.4ms。昂丹司琼(61.18%)、甲硝唑(58.18%)、环丙沙星(20.9%)、阿奇霉素(16.36%)和多潘立酮(11.81%)与qtc间期明显延长相关。女性、住院时间较长、电解质异常和年龄较大与药物引起的qt间期延长有关88.18%的处方存在延长qt间期的药物相互作用。最常见的药物相互作用是41份处方中的昂丹西琼与甲硝唑,其次是15份处方中的昂丹西琼与环丙沙星。在提出的97项干预措施中,最常见的建议是停止/避免/剂量调整(13.40%),其次是心电图监测(10.40%)。16.49%的干预措施被接受并改变治疗方法。结论:本研究表明qt间期延长在患者中普遍存在。药物性qt间期延长常与心脏药物和抗生素有关。简单的心电图和计算的QT间期可用于计划管理和提醒我们可能的电解质异常和药物治疗。目前的研究证明了常规药物审查的重要性和药剂师在多学科团队中的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A prospective study on assessment of drug induced qt interval prolongationin inpatient department at a tertiary care hospital
Objective: The present study is aimed to assess drug induced QT-interval prolongation in hospital inpatients through ECG data, predictors of risk factor for QT-interval prolongation and drug-drug interactions. Methodology: It is a prospective observational study conducted in inpatient setting. The data collected in pre design data collection form for 110 patients, who are assessed for the period of six months. The prescription with at least one QT-interval prolonging drugs were considered for this study. The collected data included demographics, mean change in QT-interval with drugs, ECG data and safety analysis data. Result: The total number of patients screened was 110. Among the study patients most of them 50.91% were older age. Major comorbidities were diabetes mellitus 39(35.45%) and hypertension 36(32.72%). There was a high prevalence (46.45%) of QT-interval prolongation. The mean QTc in prolonged group was 495±34.4ms.Ondansetron (61.18%), Metronidazole (58.18%), Ciprofloxacin (20.9%), Azithromycin (16.36%) and Domperidone (11.81%) were associated with marked QTc-interval prolongation. Female sex, longer hospitalization, electrolyte abnormalities and older age were associated with drug induced QT-interval prolongation.97 (88.18%) prescriptions showed drug interaction involving QT-interval prolongation. The most common drug interaction was found to be between ondansetron and metronidazole in 41 prescription followed by ondansetron and ciprofloxacin in 15 prescription. Of the 97 interventions proposed, the most frequent suggestion was on stop/avoid/dose adjustment (13.40%) followed by ECG monitoring (10.40%). 16.49% of interventions were accepted and therapy was changed. Conclusion: This study demonstrates the high prevalence of a prolonged QTinterval in patients. Cardiac drugs and antibiotics were frequently involved in drug induced QT-interval prolongation. A simple ECG and a calculated QT interval can be used to plan management and caution us on probable electrolyte abnormalities and drug therapies. The current study demonstrated the importance of routine medication review and the need of a pharmacist in a multidisciplinary team.
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