Burgess C, Blaikie A, Ingham T, Robinson G, Narasimhan S
Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
Intern Med J. 2006 May;36(5):289-93. doi: 10.1111/j.1445-5994.2006.01068.x.
Careful monitoring of amiodarone is recommended because it produces a range of potentially severe adverse effects. The aim of this study was to compare existing practice at our hospitals with the current international guidelines for the use of this drug.
A retrospective audit was carried out on all patients aged 15 years or older, with a primary discharge diagnosis of tachyarrhythmia and who were commenced and discharged alive on amiodarone between 1 January 2000 and 30 June 2002 from Wellington and Kenepuru Hospitals, Capital and Coast District Health Board, Wellington, New Zealand. The medical records were examined for baseline measurements of renal, liver, thyroid and pulmonary function, the electrocardiogram and chest X-ray. Follow-up arrangements were sought postdischarge. A questionnaire was sent to the general practitioner requesting information on follow-up testing.
During the trial period, 743 patients were admitted with a primary diagnosis of tachyarrhythmia. Eighty-six patients satisfied the entry criteria, and of these 58 were followed for at least 1 year postdischarge. Baseline testing of the electrocardiogram, full blood count and renal function testing was excellent (95-100%). Chest X-rays were carried out in 80% of patients. Baseline testing of thyroid (61%) and liver (44%) function was suboptimal. Two percent of patients had pulmonary function testing and no patient had a formal eye examination. At 6 months, only 32% had thyroid function tests and 41% had liver function tests. At 1 year, of those still on treatment, 35% had both liver and thyroid function tests.
Monitoring of thyroid, liver and pulmonary function tests in patients on amiodarone is less than ideal. This is probably because of lack of awareness of current guidelines.
胺碘酮会产生一系列潜在的严重不良反应，因此建议对其进行密切监测。本研究的目的是将我们医院的现有做法与当前关于该药物使用的国际指南进行比较。
对2000年1月1日至2002年6月30日期间，年龄在15岁及以上、主要出院诊断为快速性心律失常且在新西兰惠灵顿首都与海岸地区卫生局的惠灵顿医院和凯内普鲁医院开始使用胺碘酮并存活出院的所有患者进行回顾性审计。检查病历以获取肾、肝、甲状腺和肺功能的基线测量值、心电图和胸部X光片。寻求出院后的随访安排。向全科医生发送问卷，以获取有关随访检测的信息。
在试验期间，743例患者因主要诊断为快速性心律失常入院。86例患者符合入选标准，其中58例在出院后至少随访了1年。心电图、全血细胞计数和肾功能检测的基线检测情况良好（95%-100%）。80%的患者进行了胸部X光检查。甲状腺（61%）和肝功能（44%）的基线检测不理想。2%的患者进行了肺功能检测，没有患者进行正式的眼科检查。在6个月时，只有32%的患者进行了甲状腺功能检测，41%的患者进行了肝功能检测。在1年时，仍在接受治疗的患者中，35%进行了肝功能和甲状腺功能检测。
对服用胺碘酮的患者进行甲状腺、肝脏和肺功能检测的情况不太理想。这可能是因为对当前指南缺乏认识。
