Mehta Disha, Sanatani Shubhayan, Whyte Simon D
Department of Pediatric Anesthesia, British Columbia's Children's Hospital,Vancouver, BC, Canada.
Paediatr Anaesth. 2010 Oct;20(10):905-12. doi: 10.1111/j.1460-9592.2010.03408.x.
To compare the effects of droperidol and ondansetron on electrocardiographic indices of myocardial repolarization in children.
To refine understanding of the torsadogenic risk to children exposed to anti-emetic prophylaxis in the perioperative period.
QT interval prolongation is associated with torsades des pointes (TdP), but is a poor predictor of drug torsadogenicity. Susceptibility to TdP arises from increased transmural dispersion of repolarization (TDR) across the myocardial wall, rather than QT interval prolongation per se. TDR can be measured on the electrocardiogram as the time interval between the peak and end of the T wave (Tp-e). Tp-e may therefore provide a readily available, noninvasive assay of drug torsadogenicity. The perioperative period is one of high risk for TdP in children with or at risk of long QT syndromes. Droperidol and ondansetron are two drugs commonly administered perioperatively, for prophylaxis of nausea and vomiting, which can prolong the QT interval. This study investigated their effects on myocardial repolarization.
One hundred and eight ASA1-2 children undergoing elective day-case surgery were randomized to receive droperidol, ondansetron, both or neither. Pre- and post-administration 12-lead electrocardiogram (ECGs) were recorded. QT and Tp-e intervals were measured and compared within and between groups, for the primary endpoint of a 25 ms change in Tp-e.
Eighty children completed the study. There were no demographic or baseline ECG differences between groups. QT intervals lengthened by 10-17 ms after allocated treatments, with no between-group differences. Values remained within normal limits for all groups. Tp-e intervals increased by 0-7 ms, with no between-group differences. There were no instances of dysrhythmia.
Droperidol and ondansetron, in therapeutic anti-emetic doses, produce equivalent, clinically insignificant QT prolongation and negligible Tp-e prolongation, suggesting that neither is torsadogenic in healthy children at these doses.
比较氟哌利多和昂丹司琼对儿童心肌复极心电图指标的影响。
加深对围手术期接受止吐预防治疗的儿童发生尖端扭转型室速风险的理解。
QT间期延长与尖端扭转型室速（TdP）相关，但并非药物致TdP的良好预测指标。TdP的易感性源于心肌壁跨壁复极离散度（TDR）增加，而非QT间期本身延长。TDR可通过心电图测量T波顶峰与终点之间的时间间隔（Tp-e）来评估。因此，Tp-e可能提供一种易于获得的、无创的药物致TdP检测方法。围手术期是长QT综合征患儿或有长QT综合征风险患儿发生TdP的高危时期。氟哌利多和昂丹司琼是围手术期常用的两种药物，用于预防恶心和呕吐，它们均可延长QT间期。本研究调查了它们对心肌复极的影响。
108例接受择期日间手术的ASA1-2级儿童被随机分为接受氟哌利多、昂丹司琼、两者或两者均不接受治疗。记录给药前和给药后的12导联心电图（ECG）。测量QT和Tp-e间期，并在组内和组间进行比较，以Tp-e改变25 ms为主要终点。
80例儿童完成了研究。各组间人口统计学特征和基线ECG无差异。分配治疗后QT间期延长10 - 17 ms，组间无差异。所有组的值均保持在正常范围内。Tp-e间期增加0 - 7 ms，组间无差异。未发生心律失常事件。
治疗性止吐剂量的氟哌利多和昂丹司琼产生等效的、临床上无显著意义的QT延长和可忽略不计的Tp-e延长，表明在这些剂量下，这两种药物对健康儿童均无致TdP作用。
