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本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见 The possible role of propofol in drug-induced torsades de pointes: A real-world single-center analysis. 背景与目的 尖端扭转型心动过速（TdP）是与QT延长相关的多形性室性心动过速。异丙酚是对心肌细胞产生心律失常作用的镇静麻醉剂。我们进行了一项回顾性研究，以确定从1998/08/11到2015/11 / 20梅奥诊所（Rochester，MN）内丙泊酚暴露后TdP的发生率。 方 法 我们使用关键搜索词查询我们的数据库，以确定在围手术期或非手术镇静下暴露于异丙酚而发生的TdP。 QT间期是从丙泊酚暴露之前和记录TdP之后的心电图（ECG）获得的，并使用Fridericia和Framingham方法进行校正。也计算了T波波峰-波谷（Tp-e）/ QT比。 结 果 17.3年以来共有628,784例患者暴露于丙泊酚。在这些患者中，21例发展为TdP（术后12例，术中3例，镇静期6例）。有17例患者暴露于至少一种与QT延长相关的因素，包括8例患者服用QT延长药物，8例患者心率<60次/分，4例患者钾< 3.5mmol / L， 2例患者镁< 1.8mg / dL，2例患者蛛网膜下腔出血。丙泊酚暴露后，使用Fridericia矫正的QTc> 500ms的患者数量显著增高（1例患者vs 6例患者，P = 0.04）。但Framingham矫正无明显差异。 结 论 在我们的研究中，丙泊酚暴露后的TdP年发病率为1.93 /百万，常与其他危险因素相关。尽管如此，在有TdP风险的患者中应谨慎使用异丙酚。 原始文献摘要 Abrich, Victor A; Ramakrishna, Harish; Mehta, Arjun; Mookadam, Farouk; Srivathsan, Komandoor.The possible role of propofol in drug-induced torsades de pointes: A real-world single-center analysis. International Journal of Cardiology. Apr 01, 2017 . 232:243-246, BACKGROUND: Torsades de pointes (TdP) is a polymorphic ventricular tachycardia associated with QT prolongation. Propofol is a sedative-anesthetic with proarrhythmic effects on cardiac myocytes. We performed a retrospective study to determine the incidence of TdP following propofol exposure at Mayo Clinic (Rochester, MN) from 08/11/1998-11/20/2015. METHODS: We queried our database using key search terms to identify patients exposed to propofol who developed TdP perioperatively or during non-surgical sedation. QT intervals were obtained from electrocardiograms (ECGs) performed before propofol exposure and after documented TdP and were corrected using Fridericia and Framingham methods. T wave peak-to-end (Tp-e)/QT ratios were also calculated. RESULTS: A total of 628,784 patients received propofol over 17.3years. Of these patients, 21 developed TdP (12, postoperatively; 3, intraoperatively; 6, during sedation). There were 17 patients who were exposed to at least one factor associated with QT-prolongation, including QT-prolonging medications in 8 patients, heart rate <60 beats per minute in 8 patients, potassium <3.5mmol/L in 4 patients, magnesium <1.8mg/dL in 2 patients, and subarachnoid hemorrhage in 2 patients. The number of patients with QTc>500ms using Fridericia correction was significantly higher from baseline following exposure to propofol (1 patient vs 6 patients, P=0.04); however no significant difference was observed with Framingham correction. CONCLUSION: In our study, TdP after propofol administration occurred with an annual incidence of 1.93 per million and was often associated with other risk factors. Nevertheless, propofol should be administered with caution in patients at risk of developing TdP. 麻醉学文献进展分享 联系我们 |
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