危重症患者使用延长QT间期药物的药物流行病学
Pharmacoepidemiology of QT-interval prolonging drug administration in critically ill patients.
作者信息
Freeman Bradley D, Dixon David J, Coopersmith Craig M, Zehnbauer Barbara A, Buchman Timothy G
机构信息
Department of Surgery, School of Medicine, Washington University, St. Louis, MO 63110, USA.
出版信息
Pharmacoepidemiol Drug Saf. 2008 Oct;17(10):971-81. doi: 10.1002/pds.1637.
PURPOSE
Commonly prescribed medications produce QT-prolongation and are associated with torsades de pointes in non-acutely ill patients. We examined patterns of QT-prolonging drug use in critically ill individuals.
METHODS
An administrative critical care database was utilized to identify patients receiving drugs associated with QT-interval prolongation or torsades de pointes for > or = 24 hours.
RESULTS
Data from 212 016 individuals collected over a 63-month period was examined to identify 6125 patients (2.9%) receiving QT-interval prolonging drugs. These individuals had a mean (+/-SE) age of 63.0 (+/-0.2) years, were predominately male (55.4%) and Caucasian (84.4%), and were exposed to QT-interval prolonging agents for a mean (+/-SE) 53.1 (+/-0.4)% of their ICU length of stay. Respiratory and cardiovascular illnesses were the most common reasons for ICU admission (17.2, 12.0%, respectively). The most frequently administered agents were amiodarone (23.5%), haloperidol (19.8%), and levofloxacin (19.7%); no other single agent accounted for more than 10% of QT-interval prolonging drugs prescribed. Coadministration of QT-prolonging drugs occurred in 1139 patients (18.6%). These patients had higher ICU mortality rate and longer ICU lengths of stay, compared to patients not receiving coadministered drugs (p < 0.001 for both). For patients receiving coadministered drugs, overlap occurred for 71.4 (+/-0.8)% of the time that the drugs were given. Amiodarone coadministration with antibiotics, haloperidol coadministration with antibiotics, and haloperidol coadministration with amiodarone, comprised 15.2, 13.7, and 9.4%, of all coadministered agents, respectively.
CONCLUSIONS
QT-prolonging drugs were used in a minority of critically ill patients. Prospective evaluation in the ICU environment is necessary to determine whether administration of these agents is associated with adverse cardiac events comparable to those reported in ambulatory patients.
目的
常用药物可导致QT间期延长，并与非危重症患者的尖端扭转型室速相关。我们研究了危重症患者中QT间期延长药物的使用模式。
方法
利用一个行政重症监护数据库，识别接受与QT间期延长或尖端扭转型室速相关药物治疗≥24小时的患者。
结果
对63个月期间收集的212016例患者的数据进行分析，以识别6125例（2.9%）接受QT间期延长药物治疗的患者。这些患者的平均（±标准误）年龄为63.0（±0.2）岁，男性占主导（55.4%），白种人占84.4%，在重症监护病房（ICU）住院期间，他们接受QT间期延长药物治疗的时间平均（±标准误）占53.1（±0.4）%。呼吸和心血管疾病是入住ICU最常见的原因（分别为17.2%、12.0%）。最常使用的药物是胺碘酮（23.5%）、氟哌啶醇（19.8%）和左氧氟沙星（19.7%）；没有其他单一药物在开具的QT间期延长药物中占比超过10%。1139例患者（18.6%）联合使用了QT间期延长药物。与未接受联合用药的患者相比，这些患者的ICU死亡率更高，ICU住院时间更长（两者p均<0.001）。对于接受联合用药的患者，药物使用重叠时间占71.4（±0.8）%。胺碘酮与抗生素联合使用、氟哌啶醇与抗生素联合使用以及氟哌啶醇与胺碘酮联合使用，分别占所有联合用药的15.2%、13.7%和9.4%。
结论
少数危重症患者使用了QT间期延长药物。有必要在ICU环境中进行前瞻性评估，以确定使用这些药物是否会引发与门诊患者报告的类似不良心脏事件。
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