胺碘酮的肺毒性及其防治.pdfVIP

22 药物不良反应杂志 2008年 2月第 10卷第 1期 ADRJ, February, 2008, Vol10. N o. 1 胺碘酮的肺毒性及其防治 陶海龙 马长生 ( , 100029) 胺碘酮属类抗心律失常药,用于室性心律失常心房颤动等的预防治疗长期用药 生不良反应的风险增加,其中以肺 毒性最为常见, 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 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 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 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 胺碘酮; 肺毒性; 不良反应 R 972. 2 : A : 2008) 1002207 Am iodarone pulmonary toxicity and its prevention and managem ent TaoHailong, aChangsheng (Department of Cardiology, eij ing AnzhenH osp ital, Cap italM ed ical University, eij ing 100029, China) ABSTRACT Am iodarone is a class III antiarrhythem ic. 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 am iodarone is pulmonary toxicity. The reported incidence of amiodaronepulmonary toxicity(APT) is variable, but appears to bebetween 1% and 17%. ost of the patients develop interstitialpneumonitis or hypersensitivity pneumonitis after 3~ 12months of amiodarone therapy. The pathogenesis of am iodarone pulmonary toxicity is uncertain. The possiblemechanisms include direct cytotoxicity, hypersensitivity, inflammatory or mi mune response. The related factors inducingAPT are preexisting lung disease and high dosage or longterm use of amiodarone. The clinical presentations ofAPT arenonspecific, andmain symptoms are nonproductive cough, dyspnea, weakness, weight loss, and fever. The alveolarand interstitial inflammation is frequent on the chest roentgenogram. The clinical diagnosis of APT should be considered when a patientdevelops the following findings: new orworsened symptoms, new abnormalities orworsening on the chest roentgenograms and a 15 percent dec