围手术期使用昂丹司琼或多拉司琼不会延长QT间期

2021-12-17 17:26

围手术期使用昂丹司琼或多拉司琼不会延长QT间期。

本文由“罂粟花”授权转载

围手术期使用昂丹司琼或多拉司琼不会延长QT间期

贵州医科大学麻醉与心脏电生理课题组

翻译：刘云琴编辑：陈锐审校：曹莹

目的

为了验证昂丹司琼或多拉司琼可使非心脏手术患者的心率校正QT间期（QTc间期）延长会超过60ms或增加QTc超过500ms的患者比例的假设，第二个假设是糖尿病患者QTc间期延长更严重

方法

我们从克利夫兰诊所的围手术期健康记录系统中提取了2006年3月25日至2010年9月30日的数据，并从克利夫兰诊所药房的Epic销售成本（COGS）系统中提取额外的围手术期药物。我们寻找了术前、术后1个月内，术后2小时内心电图检查的患者。我们排除了围手术期服用昂丹司琼或多拉司琼以外的止吐药的患者，以及服用胺碘酮的患者：。

主要结果

共有1429名患者服用5-羟色胺-3受体（5HT3R）拮抗剂，1022名对组（n¼220）术后QTc超过500ms。5HT3R拮抗剂患者术前和术后QTc标准差分别为438±37ms和464±41ms，对照组患者分别为443±40ms和469±47ms。两组围手术期QTc值的单变量标准差增加分别为26±39和26±48ms。调整混杂变量后，服用和未服用5HT3R拮抗剂的患者QTc值的平均增加没有差异。分别为0.1毫秒（97.5%CI，e5.2至5.0毫秒；多变量P=0.97)。给予5HT3R拮抗剂的糖尿病患者QTc值延长，但无显著性差异（P=0.16）

HOLIDAY

结论

与基线检查相比，QTc平均延长仅为6%。围手术期使用昂丹司琼或多拉司琼与QT间期延长无关，且这些结果不因糖尿病状态而改变。围手术期使用5HT3R拮抗剂不会产生潜在的危险性围手术期心电图改变，并且似乎也不需要食品和药物管理局发出药物安全警告.

原始文献来源

Obal Detlef,Yang Dongsheng,Sessler Daniel I et al.,Perioperative doses of ondansetron or dolasetron do not lengthen the QT interval.[J] .Mayo Clin Proc, 2014, 89: 69-80.

Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery

Abstract：

OBJECTIVE:To test the primary hypothesis that ondansetron or dolasetron extends the rate-corrected QT electrocardiographic interval (QTc) greater than 60 milliseconds or increases the fraction of patients with QTc greater than 500 milliseconds in patients having noncardiac surgery, and the secondary hypothesis that QTc prolongation is worse in diabetic patients.

PATIENTS AND METHODS:We extracted data from the Cleveland Clinic's Perioperative Health Documentation System between March 25, 2006, and September 30, 2010, and additional perioperative medications from Cleveland Clinic pharmacy's Epic Cost of Goods Sold (COGS) system. We searched for patients who had a preoperative electrocardiogram within 1 month of surgery and postoperatively within 2 hours. We excluded patients given an antiemetic drug other than ondansetron or dolasetron perioperatively, and those given amiodarone.

RESULTS:A total of 1429 patients given serotonin-3 receptor (5HT3R) antagonists and 1022 controls met the enrollment criteria. Seventeen percent of patients given 5HT3R antagonists (n=242) and 22% of controls (n=220) had postoperative QTc exceeding 500 milliseconds. Mean ± SD presurgical and postsurgical QTc, respectively, were 438±37 milliseconds and 464±41 milliseconds for 5HT3R antagonist patients and 443±40 milliseconds and 469±47 milliseconds for control patients. Univariable mean ± SD perioperative increases in QTc were 26±39 and 26±48 milliseconds in the 2 groups. After adjusting for confounding variables, there were no differences in the mean increase in QTc in patients who were and were not given 5HT3R antagonists: -0.1 milliseconds (97.5% CI, -5.2 to 5.0 milliseconds; multivariable P=.97). The QTc was prolonged, but not significantly, in diabetic patients given 5HT3R antagonists (P=.16).

CONCLUSIONS:The average QTc prolongation from baseline was only 6%. Perioperative use of ondansetron or dolasetron was not associated with extended QT prolongation, and these results did not vary by diabetic status. Perioperative use of 5HT3R antagonists does not produce potentially dangerous perioperative electrocardiographic changes and does not seem to warrant a drug safety warning from the Food and Drug Administration.