目的 調(diào)查分析首都醫(yī)科大學(xué)附屬北京安定醫(yī)院喹硫平導(dǎo)致心血管系統(tǒng)藥品不良反應(yīng)的特點。方法 選取2014-2023年首都醫(yī)科大學(xué)附屬北京安定醫(yī)院上報國家不良反應(yīng)中心的121例喹硫平致心血管系統(tǒng)不良反應(yīng)的病例,分析患者的不良反應(yīng)及藥物治療情況,治療措施及轉(zhuǎn)歸等方面,探討喹硫平導(dǎo)致心血管系統(tǒng)不良反應(yīng)的臨床特點。結(jié)果 121例患者中,女性占比(61.98%)較大。原患疾病以雙相情感障礙為主,為51例(42.15%)。發(fā)生不良反應(yīng)時,用藥劑量均較低,僅12例患者劑量超過700 mg/d。不良反應(yīng)以直立性低血壓為主(42.98%)。不良反應(yīng)多發(fā)生在用藥初期,大部分在用藥10 d內(nèi)出現(xiàn)癥狀。不良反應(yīng)的臨床表現(xiàn)方面,直立性低血壓患者收縮壓和舒張壓呈不同程度的降低。患者出現(xiàn)不良反應(yīng)后,及時處理并密切觀察不良反應(yīng)情況,癥狀均緩解或恢復(fù)正常。結(jié)論 喹硫平在較小日劑量使用時,仍有導(dǎo)致心血管不良反應(yīng)的風(fēng)險。喹硫平還可引起罕見的不良反應(yīng),包括心悸、高血壓、QT間期延長、心動過緩等。其中QT間期延長是較為嚴(yán)重的不良反應(yīng),可能導(dǎo)致更嚴(yán)重的不良反應(yīng)發(fā)生,如心源性猝死。對于存在先天性長QT綜合征、心衰、女性、老年等危險因素時,使用喹硫平期間務(wù)必做好全面檢查,在藥物治療初期,應(yīng)進(jìn)行電解質(zhì)和心電圖監(jiān)護(hù)等,避免更嚴(yán)重的不良反應(yīng)發(fā)生。

Objective To investigate and analyze the characteristics of adverse drug reactions in cardiovascular system caused by quetiapine in Beijing Anding Hospital Affiliated to Capital Medical University. Methods 121 Cases of adverse cardiovascular reactions caused by quetiapine reported to the National Adverse Reaction Center in Beijing Anding Hospital Affiliated to Capital Medical University from 2014 to 2023 were selected and analyzed. Adverse reactions, drug treatment, treatment measures and outcomes of patients were analyzed in detail, and the clinical characteristics of adverse cardiovascular reactions caused by quetiapine were discussed. Results Among the 121 patients, women accounted for a large proportion (61.98%). The primary disease was bipolar disorder, 51 cases (42.15%). When adverse reactions occurred, the dosage was low, and only 12 patients had a dose of more than 700 mg/d. Orthostatic hypotension accounted for a large proportion (42.98%). Most of the adverse reactions occurred in the early stage of medication, and most of the adverse reactions appeared within 10 d of medication. In terms of clinical manifestations of adverse reactions, systolic and diastolic blood pressure were reduced in patients with orthostatic hypotension to varying degrees. After adverse reactions occurred, patients were treated in time and adverse reactions conditions were closely observed, and symptoms were relieved or returned to normal. Conclusions Quetiapine is still at risk of cardiovascular adverse events at smaller daily doses. Quetiapine can also cause rare adverse reactions, including palpitations, hypertension, QT interval prolongation, bradycardia, etc. QT interval prolongation is a more serious adverse reaction, which may lead to more serious adverse reactions, such as sudden cardiac death. For the presence of congenital long QT syndrome, heart failure, female, elderly and other risk factors, it is necessary to do a comprehensive examination during the use of quetiapine, in the early stage of drug treatment, electrolyte and electrocardiogram monitoring should be carried out to avoid more serious adverse reactions.

R971