羅敏 1 , 李思遠 2 , 唐堯 1
  • 四川大學華西醫(yī)院（成都，610041）1 藥劑科，2 老年科;

【摘要】　目的　 報道1例靜脈滴注胺碘酮致肝腎功能不全患者。　方法　 2010年10月收治1例擴張性心肌病患者，治療過程中使用胺碘酮注射液，導致嚴重的肝腎功能不全。系統(tǒng)查閱中國期刊全文數(shù)據(jù)庫及外文數(shù)據(jù)庫Pubmed、Embase建庫至2011年8月關于胺碘酮致肝腎功能不全的相關文獻，進行靜脈胺碘酮致肝腎功能不全的可能性評估，探索胺碘酮靜脈滴注致肝功能不全的的作用機制。　結果　 根據(jù)查閱文獻結果分析，此患者靜脈注射胺碘酮致肝功不全的可能性高，Naranjo概率評分分別為7分。　結論　 提出臨床醫(yī)師和臨床藥師應進行胺碘酮靜脈的藥學監(jiān)護，高度的重視胺碘酮相關的不良反應，從而及時識別和防治胺碘酮所致肝腎功能不全，減少其不良預后。
【Abstract】　Objective　 To report a case of hepatic and renal insufficiency induced by intravenous injection with amiodarone, and to evaluate the possibility of the adverse drug reaction.　Methods　 A patient with dilated cardiomyopathy was admitted in October, 2010. During the procedure, the use of amiodarone hydrochloride injection made the patient suffer from liver and kidney dysfunction. We retrieved the literatures about liver and kidney toxicity of amiodarone from CNKI, Pubmed, and Embase (from the establishment of the databases to November 2011). We also ssessed the possibility of the adverse drug reaction, discussed the mechanism of amiodarone-induced hepatic insufficiency.　Results　 According to the literature, There was a great possibility of hepatic insufficiency induced by amiodarone, and the total score of the Naranjo probability score was 7.　Conclusion　 It is important to pay more attention to the pharmaceutical care of amidarone to timely recognize and effectively prevent or treat hepatic and renal insufficiency induced by intravenous injection with amiodarone.

引用本文： 羅敏,李思遠,唐堯. 靜脈滴注胺碘酮致肝腎功能不全一例及文獻分析. 華西醫(yī)學, 2011, 26(11): 1611-1614. doi: 復制

版權信息： ?四川大學華西醫(yī)院華西期刊社《華西醫(yī)學》版權所有，未經授權不得轉載、改編

1. 　Vassallo P, Trohman RG. Prescribing amiodarone: an evidence-based review of clinical indications[J]. JAMA. 2007, 298(11): 1312-1322.
2. 　Goldschlager N, Epstein AE, Naccarelli GV, et al. A practical guide for clinicians who treat patients with amiodarone: 2007[J]. Heart Rhythm, 2007, 4(9): 1250-1259.
3. 　中國生物醫(yī)學工程學會心律分會, 中華醫(yī)學會心血管病學分會, 胺碘酮抗心律失常治療應用指南工作組. 胺碘酮抗心律失常治療應用指南(2008)[J]. 中國心臟起搏與心電生理雜志, 2008, 22(5): 377-385.
4. 　黃興福, 楊艷敏, 朱俊, 等. 靜脈胺碘酮的主要不良反應分析[J]. 中國心臟起搏與心電生理雜志, 2007, 2l(6): 485-488.
5. 　Emanuela R, Elena I, Roberto M, et al. Acute toxic hepatitis after amiodarone intravenous loading[J]. Am J Emerg Med, 2007, 25: 1082e1-1082e4.
6. 　溫偉, 紀立偉, 張新超. 胺碘酮靜脈滴注致急性肝損害15例臨床分析[J]. 藥物不良反應雜志, 2006, 8(2): 105-109.
7. 　黃興福, 楊艷敏, 朱俊. 靜脈胺碘酮與嚴重肝功能損害[J]. 中國心臟起搏與心電生理雜志, 2009, 23(6): 477-479.
8. 　Mountfield RJ, Senepin S, Schleimer M, et al. Potential inhibitory effects of formulation ingredients on intestinal cytochrome P450[J]. Int J Pharm, 2000, 211(1-2): 89-92.
9. 　Rhodes A, Eastwood JB, Smith SA. Early acute hepatitis with parental amiodarone: a toxic effect of the vehicle?[J]. Gut, 1993, 34: 565-566.
10. 　Hirama S, Tatsuishi T, 1wase K, et al. Flow-cytometric analysis on adverse effects of polysorbate 80 in rat thymocytes[J]. Toxicology, 2004, 199(2-3): 137-143.
11. 　Anja Z, Karin B, Rejane M. The role of CYP3A4 in amiodarone-associated toxicity on HepG2 cells[J]. Biochem Pharmacol, 2011, 81(3): 432-441.
12. 　Tisdale JE, Follin SL, Ordelova A, et al. Risk factors for the development of specific noncardiovascular adverse effects associated with amiodarone[J]. J Clin Phamacol, 1995, 35(4): 351-356.
13. 　Mattar W, Juliar B, Gradus-Pizlo I, et al. Amiodarone hepatotoxicity in the context of the metabolic syndrome and right-sided heart failure[J]. Gastrointestin Liver Dis, 2009, 18(4): 419-423.
14. 　Kum LC, Chan WW, Hui HH, et al. Prevalence of amiodarone-related hepatotoxicity in 720 Chinese patients with or without baseline liver dysfunction[J]. Clin Cardiol, 2006, 29(7): 295-299.
  1. 1. 　Vassallo P, Trohman RG. Prescribing amiodarone: an evidence-based review of clinical indications[J]. JAMA. 2007, 298(11): 1312-1322.
  2. 2. 　Goldschlager N, Epstein AE, Naccarelli GV, et al. A practical guide for clinicians who treat patients with amiodarone: 2007[J]. Heart Rhythm, 2007, 4(9): 1250-1259.
  3. 3. 　中國生物醫(yī)學工程學會心律分會, 中華醫(yī)學會心血管病學分會, 胺碘酮抗心律失常治療應用指南工作組. 胺碘酮抗心律失常治療應用指南(2008)[J]. 中國心臟起搏與心電生理雜志, 2008, 22(5): 377-385.
  4. 4. 　黃興福, 楊艷敏, 朱俊, 等. 靜脈胺碘酮的主要不良反應分析[J]. 中國心臟起搏與心電生理雜志, 2007, 2l(6): 485-488.
  5. 5. 　Emanuela R, Elena I, Roberto M, et al. Acute toxic hepatitis after amiodarone intravenous loading[J]. Am J Emerg Med, 2007, 25: 1082e1-1082e4.
  6. 6. 　溫偉, 紀立偉, 張新超. 胺碘酮靜脈滴注致急性肝損害15例臨床分析[J]. 藥物不良反應雜志, 2006, 8(2): 105-109.
  7. 7. 　黃興福, 楊艷敏, 朱俊. 靜脈胺碘酮與嚴重肝功能損害[J]. 中國心臟起搏與心電生理雜志, 2009, 23(6): 477-479.
  8. 8. 　Mountfield RJ, Senepin S, Schleimer M, et al. Potential inhibitory effects of formulation ingredients on intestinal cytochrome P450[J]. Int J Pharm, 2000, 211(1-2): 89-92.
  9. 9. 　Rhodes A, Eastwood JB, Smith SA. Early acute hepatitis with parental amiodarone: a toxic effect of the vehicle?[J]. Gut, 1993, 34: 565-566.
  10. 10. 　Hirama S, Tatsuishi T, 1wase K, et al. Flow-cytometric analysis on adverse effects of polysorbate 80 in rat thymocytes[J]. Toxicology, 2004, 199(2-3): 137-143.
  11. 11. 　Anja Z, Karin B, Rejane M. The role of CYP3A4 in amiodarone-associated toxicity on HepG2 cells[J]. Biochem Pharmacol, 2011, 81(3): 432-441.
  12. 12. 　Tisdale JE, Follin SL, Ordelova A, et al. Risk factors for the development of specific noncardiovascular adverse effects associated with amiodarone[J]. J Clin Phamacol, 1995, 35(4): 351-356.
  13. 13. 　Mattar W, Juliar B, Gradus-Pizlo I, et al. Amiodarone hepatotoxicity in the context of the metabolic syndrome and right-sided heart failure[J]. Gastrointestin Liver Dis, 2009, 18(4): 419-423.
  14. 14. 　Kum LC, Chan WW, Hui HH, et al. Prevalence of amiodarone-related hepatotoxicity in 720 Chinese patients with or without baseline liver dysfunction[J]. Clin Cardiol, 2006, 29(7): 295-299.