1例心力衰竭合并慢性肾功能不全患者重复使用左西孟旦致尖端扭转型室性心动过速用药分析与药学监护
Medication Analysis and Pharmaceutical Care of Repeated Use of Levosimendan-Induced Torsade de Pointes in a Patient with Heart Failure and Chronic Kidney Insufficiency
王艳玲 1张青霞1
作者信息
- 1. 首都医科大学宣武医院·国家老年疾病临床医学研究中心,北京 100053
- 折叠
摘要
目的 促进左西孟旦的临床合理、规范应用.方法 分析和评估 1 例心力衰竭合并慢性肾功能不全患者重复使用左西孟旦致低血压、尖端扭转型室性心动过速和心室颤动的危险因素、发生机制及防治措施.结果 慢性肾功能不全患者重复使用左西孟旦,因肾功能损害可能导致该药活性代谢物浓度增加,引起更明显、持久的血流动力学效应,短时间内重复用药可能会导致药物浓度叠加,增加药品不良反应.在低血钾等导致QT间期延长的因素的共同作用下,进而导致尖端扭转型室性心动过速、心室颤动等恶性心律失常.结论 临床医师应充分了解左西孟旦的药理学作用及代谢特点,加强用药期间的监护,促进临床合理用药,确保患者用药安全.
Abstract
Objective To promote the rational and standardized clinical application of Levosimendan.Methods The risk factors,mechanism,prevention and treatment of severe adverse drug reactions such as hypotension,torsades de pointes(TdP)and ventricular fibrillation(VF)induced by repeated use of levosimendan in a patient with heart failure and chronic renal insufficiency were analyzed and evaluated.Results Repeated use of levosimendan in a patient with chronic renal insufficiency might increase concentrations of the active metabolites of levosimendan due to impaired renal function,resulting in more obvious and lasting hemodynamics effects,repeated use in a short period might result in drug concentration stacks and increase the risk of adverse drug reactions.Malignant arrhythmias such as TdP and VF were caused by a combination of factors such as hypokalemia that lead to prolonged QT intervals.Conclusion Clinicians should fully understand the pharmacological effects and metabolic characteristics of levosimendan and strengthen the monitoring during medication,to promote rational drug use in the clinic,in order to ensure the patients'medication safety.
关键词
左西孟旦/心力衰竭/肾功能不全/低血压/QT间期/尖端扭转型室性心动过速/药学监护Key words
levosimendan/heart failure/chronic renal insufficiency/hypotension/QT interval/torsades de pointes/pharmaceutical care引用本文复制引用
基金项目
国家重点研发计划(2020YFC2008305)
出版年
2024
国家科技期刊平台
NSTL
万方数据