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目的探讨抗菌药物诱导尖端扭转型室速(torsade de pointes,TDP)的规律及特点,为临床合理用药提供参考。方法检索中国期刊全文数据库、维普、万方、中国生物医学文献数据库建库至2011年7月有关抗菌药物致TDP的病例报道,共16例,并进行分析。结果 16例患者中男3例,女13例;年龄17～88岁,平均54岁。6例患者存在心脏疾病;诱导TDP的抗菌药物包括常用的莫西沙星、司帕沙星、头孢拉定、头孢哌酮、磷霉素、克林霉素、两性霉素B、氟康唑、伊曲康唑以及不常用的红霉素、酮康唑;TDP发生时间为用药后(5.1±6.6)d,多数患者先出现心悸、心电图提示QTc间期延长,进而出现TDP。结论临床医师、药师应重视抗菌药物诱导TDP的不良反应。
Objective To investigate the rules and characteristics of torsade de pointes (TDP) induced by antimicrobial agents and provide references for rational drug use in clinic. Methods A total of 16 cases of TDP induced by antibacterials were searched from the Chinese Journal Full-text Database, VIP, Wanfang, China Biomedical Literature Database to July 2011, and analyzed. Results 16 patients were 3 males and 13 females, aged 17 to 88 years, mean 54 years old. Six patients had heart disease; antimicrobial agents that induced TDP included the usual moxifloxacin, sparfloxacin, cefradine, cefoperazone, fosfomycin, clindamycin, amphotericin B, fluconazole, Conazole and less commonly used erythromycin, ketoconazole; TDP occurred after treatment (5.1 ± 6.6) d, the majority of patients first palpitations, ECG QTc interval prolongation, and then appear TDP. Conclusion Clinicians and pharmacists should pay attention to the adverse reactions induced by antimicrobial agents.