Oragano Carol Ann, Patton Declan, Moore Zena
Carol Ann Oragano is a cardiac nurse specialist in Urgent Cardiac Care, Mater Private, Dublin, Ireland.
Declan Patton is a senior lecturer and director of nursing and midwifery research, School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland.
Crit Care Nurse. 2019 Feb;39(1):e1-e12. doi: 10.4037/ccn2019381.
Intravenous amiodarone is the gold-standard treatment for arrhythmias, but phlebitis is a common adverse effect.
To determine the incidence and contributing factors of amiodarone-induced phlebitis and examine phlebitis severity.
A systematic review was conducted of articles published before February 2016 in the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, MEDLINE, Embase, Web of Science, and gray databases (Bielefeld, Lenus, EUGrey, RIAN, and DART). All studies in which amiodarone-induced phlebitis was a primary or secondary outcome were included. Meta-analysis was not appropriate because of study heterogeneity. Studies of the same contributing factors were analyzed together.
In the 20 included studies, phlebitis incidence ranged from 0% to 85%. Increasing the infusion concentration from 1.2 mg/mL to 1.8 mg/mL increased the phlebitis rate ( < .001). Total amiodarone doses greater than 1 g resulted in higher phlebitis rates than did doses less than 0.45 mg ( < .001). Most infusion durations and rates were not correlated with phlebitis incidence. However, phlebitis incidence was lower with bolus administration than with longer infusions ( = .002). The use of in-line filters and nursing guidelines significantly reduced phlebitis rates ( < .001) and phlebitis severity. The most common phlebitis severity grades, in descending order, were 0, 1, 2, 3, and 4.
Understanding factors that increase the risk of amiodarone-induced phlebitis can guide better practice. In-line filters and nursing guidelines should always be implemented when administering intravenous amiodarone. Increased surveillance is required when higher dosages and concentrations are used.
静脉注射胺碘酮是心律失常的金标准治疗方法，但静脉炎是一种常见的不良反应。
确定胺碘酮所致静脉炎的发生率及相关因素，并评估静脉炎的严重程度。
对2016年2月之前发表在护理及相关健康文献累积索引、考克兰图书馆、医学期刊数据库、荷兰医学文摘数据库、科学引文索引数据库及灰色数据库（比勒费尔德、莱纳斯、欧洲灰色文献数据库、俄罗斯国家科技信息系统及药物不良反应通报数据库）中的文章进行系统综述。纳入所有以胺碘酮所致静脉炎作为主要或次要结局的研究。由于研究的异质性，不适合进行荟萃分析。对相同相关因素的研究进行综合分析。
在纳入的20项研究中，静脉炎发生率为0%至85%。将输注浓度从1.2毫克/毫升提高到1.8毫克/毫升会增加静脉炎发生率（P<0.001）。胺碘酮总剂量大于1克时的静脉炎发生率高于剂量小于0.45毫克时（P<0.001）。大多数输注持续时间和速率与静脉炎发生率无关。然而，推注给药的静脉炎发生率低于较长时间输注（P = 0.002）。使用在线过滤器和护理指南可显著降低静脉炎发生率（P<0.001）及静脉炎严重程度。最常见的静脉炎严重程度分级，从高到低依次为0级、1级、2级、3级和4级。
了解增加胺碘酮所致静脉炎风险的因素有助于优化治疗方案。静脉注射胺碘酮时应始终使用在线过滤器并遵循护理指南。使用较高剂量和浓度时需要加强监测。
