Vlasses P H, Ferguson R K, Rocci M L, Raja R M, Porter R S, Greenspan A M
Am J Nephrol. 1986;6(2):112-6. doi: 10.1159/000167065.
Four patients, 64-80 years of age, with severe renal dysfunction and heart disease received conventional doses of procainamide as treatment for cardiac arrhythmias. Serum procainamide concentrations at these times ranged from 6.2 to 13.3 micrograms/ml and were within the recently expanded therapeutic range for resistant ventricular arrhythmias. All 4 patients demonstrated marked and delayed accumulation of the active metabolite N-acetylprocainamide, with highest observed serum concentrations ranging from 42.0 to 59.4 micrograms/ml. Cardiotoxicity associated with these levels included progressive widening of the QRS and corrected Q-T intervals, induction of polymorphic non-sustained ventricular tachycardia (torsades de pointes), and severe depression of left ventricular function which appeared to be important factors in the deaths of these patients. The use of lower procainamide doses and careful anticipatory monitoring of serum concentrations of procainamide and N-acetylprocainamide are essential in this high-risk group.
4名年龄在64至80岁之间、患有严重肾功能不全和心脏病的患者接受了常规剂量的普鲁卡因胺治疗心律失常。此时血清普鲁卡因胺浓度范围为6.2至13.3微克/毫升，处于最近扩大的耐药室性心律失常治疗范围内。所有4名患者均表现出活性代谢产物N - 乙酰普鲁卡因胺的显著且延迟蓄积，观察到的最高血清浓度范围为42.0至59.4微克/毫升。与这些水平相关的心脏毒性包括QRS波和校正QT间期逐渐增宽、诱发多形性非持续性室性心动过速（尖端扭转型室速）以及左心室功能严重减退，这些似乎是导致这些患者死亡的重要因素。在这个高危人群中，使用较低剂量的普鲁卡因胺并仔细预先监测普鲁卡因胺和N - 乙酰普鲁卡因胺的血清浓度至关重要。
