TOXIC AND THERAPEUTIC EFFECTS OF AMIODARONE IN THE TREATMENT OF CARDIAC-ARRHYTHMIAS
TOXIC AND THERAPEUTIC EFFECTS OF AMIODARONE IN THE TREATMENT OF CARDIAC-ARRHYTHMIAS
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DOI：
10.1016/s0735-1097(83)80338-6
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发表时间：
1983-01-01
影响因子：
24
通讯作者：
TROBAUGH, GB
中科院分区：
文献类型：
--
作者：
GREENE, HL;GRAHAM, EL;TROBAUGH, GB
胺碘酮被用于治疗常规药物治疗难治的心律失常。在这项研究中，连续使用胺碘酮治疗的前70名患者至少有6个月。这是后续行动的基础，也是本报告的基础。其中66例为室性心律失常，4例为室上性心动过速。胺碘酮治疗包括负荷量600 mg，每日2次，连续7天，此后每天600 mg。只有在出现副作用的情况下，剂量才会减少。由于频繁的副作用，剂量从572.+-减少。283/毫克日(平均+-SD)，45天至372。+-。174 mg/d，6mo。平均随访11个月。在54例继续服用胺碘酮的患者中，仅有4例患者发生了室颤。另有3例患者在长期随访中出现复发性持续性室性心动过速。所有70名患者在随访中都进行了广泛的临床和实验室评估。副作用很常见，93%的患者会出现副作用。13名患者(19%)因严重副作用而不得不停止服药。56名患者出现胃肠道副作用，最常见的是便秘。除1例患者外，其余患者最终均出现角膜微沉着，43例患者出现症状。心血管副作用并不常见。7例患者出现症状性肺部副反应，5例出现明确的肺部毒性。52例患者出现神经系统副反应，最常见的是震颤和共济失调。甲状腺功能障碍3例，皮肤异常32例。32例患者出现其他各种副作用。胺碘酮在难治性心律失常的治疗中似乎是有用的。由于几乎所有患者在每天给予600毫克的维持量时都会出现副作用，因此应该使用较低的维持量。目前尚不清楚更严重的副作用是否与剂量有关。胺碘酮的毒性治疗范围较窄，负荷期较长，给药困难。更重要的是，抗心律失常失败的第一个症状可能是心脏性猝死。
Amiodarone was used to treat cardiac arrhythmias that had been refractory to conventional medical therapy. The 1st 70 consecutive patients treated with amiodarone in this study had at least 6 mo. of follow-up and form the basis for this report. Sixty-six patients were treated for ventricular arrhythmias and 4 for supraventricular tachycardias. Amiodarone therapy consisted of a loading dose of 600 mg orally twice a day for 7 days and 600 mg daily thereafter. Doses were reduced only if side effects occurred. Because of frequent side effects, the dose was reduced from 572 .+-. 283/mg day (mean .+-. SD) at 45 days to 372 .+-. 174 mg/day at 6 mo. With a mean follow-up of 11 mo. in the 54 patients who continued to take amiodarone, only 4 patients had ventricular fibrillation. Three additional patients experienced recurrent sustained ventricular tachycardia in long-term follow-up. All 70 patients had extensive clinical and laboratory evaluation in follow-up. Side effects were common, occurring in 93% of patients. Thirteen patients (19%) had to discontinue the medication because of severe side effects. Fifty-six patients had gastrointestinal side effects, most commonly constipation. All patients but 1 eventually developed corneal microdeposits and 43 patients were symptomatic. Cardiovascular side effects were uncommon. Symptomatic pulmonary side effects occurred in 7 patients, with unequivocal pulmonary toxicity occurring in 5. Neurologic side effects, most commonly tremor and ataxia, occurred in 52 patients. Thyroid dysfunction occurred in 3 patients and 32 patients had cutaneous abnormalities. Miscellaneous other side effects occurred in 32 patients. Amiodarone appears to be useful in the management of refractory arrhythmias. Because virtually all patients develop side effects when given a maintenance daily dose of 600 mg, lower maintenance doses should be used. It is unknown if the more severe side effects are dose-related. Amiodarone is difficult to administer because of its narrow toxic-therapeutic range and prolonged loading phase. More importantly, the 1st sign of antiarrhythmic failure may be manifest as sudden cardiac death.