摘要
胺碘酮属Ⅲ类抗心律失常药,用于室性心律失常、心房颤动等的预防治疗。长期用药发生不良反应的风险增加,其中以肺毒性最为常见,发生率为1%～17%,多在连续用药3～12月后出现间质性肺炎或过敏性肺炎。胺碘酮致肺毒性的机制尚不明确,可能为药物直接细胞毒性作用,过敏反应、炎性反应或免疫反应的结果;患者原有肺部疾病、药物剂量较大或使用时间过长与肺毒性相关。临床主要表现为干咳、呼吸困难、乏力、体重下降、发热等。胸片以肺实质和间质同时受累最为常见。应用胺碘酮后,出现新发症状或原症状加重,新出现的胸片异常或胸部病变加重,肺功能检查示CO或肺总量下降>15%,应考虑为肺毒性反应。建议使用胺碘酮前进行利益/风险评价,长期用药应使用最小有效剂量,定期检测肺功能,以减少和及时发现肺毒性。一旦临床诊断为肺毒性,应及时减量和停药,多数患者停药后可缓解,严重者可短期使用皮质激素治疗。
Amiodarone is a class Itt antiarrhythemic. It is used in the control of ventricular arrhythmias and atrial fibrillation. Amiodarone can induce a varity of adverse reactions. The one of the common serious adverse reactions to amiodarone is pulmonary toxicity. The reported incidence of amiodarone pulmonary toxicity（APT） is variable, but appears to be between 1% and 17%. Most of the patients develop interstitial pneumonitis or hypersensitivity pneumonitis after 3 - 12 months of antiodarone therapy. The pathogenesis of amiodarone pulmonary toxicity is uncertain. The possible mechanisms include direct cytotoxicity, hypersensitivity, inflammatory or immune response. The related factors inducing APT are preexisting lung disease and high dosage or long-term use of amiodarone. The clinical presentations of APT are nonspeeific, and main symptoms are nonproductive cough, dyspnea, weakness, weight loss, and fever. The alveolar and interstitial inflammation is frequent on the chest roentgenogram. The clinical diagnosis of APT should be considered when a patient develops the following findings： new or worsened symptoms, new abnormalities or worsening on the chest roentgenograms and a 15 percent decrease in the CO or total lung capacity. It is recommended that the benefit-risk ratio be evaluated before start of amiodarone therapy, the smallest effective dosage be used for long-term treatment, and the pulmonary function be examined at regular intervals. Once the clinical diagnosis of Airy is made, the most common option is to decrease the dosage or discontinue amiodarone. Most patients＇signs and symptoms resolve after the cessation of amiodarone. The patient with severe pulmonary toxicity may be administered with short-term corticosteroid therapy.
出处
《药物不良反应杂志》
2008年第1期22-28,共7页
Adverse Drug Reactions Journal
关键词
胺碘酮
肺毒性
不良反应
amiodarone
pulmonary toxicity
adverse drug reaction
