背景:芬太尼是急诊科(ED)经常使用的阿片类镇痛药,通常在不知道患者QTC值或不进行监测的情况下给药。然而,芬太尼对QTC的影响,延长或缩短,尚未阐明。本研究旨在确定芬太尼对QTC的影响。
方法:这是一项在三级医院的ED中进行的前瞻性观察性研究,对象是接受静脉内芬太尼用于插管以外的手术的患者。在开始芬太尼给药之前和开始后1、5、15、30和60分钟进行心电图检查,并计算QTC值。主要结果是QTC延长,定义为QTC增加至≥500ms或QTC增加≥60ms。
结果:该研究包括109名患者。其中,60例患者为男性,中位年龄为40岁。与基线QTC值相比,在5日检测到有统计学意义的延长,15th,30日,第60分钟,在30分钟时最大延长,中位数为13.08ms.大多数QTC延长患者为女性,年龄在40岁以上。临床上,在60分钟的监测观察期内,这些患者均未出现恶性心律失常.
结论:芬太尼可显著延长QTC值。尽管临床上没有患者出现恶性心律失常,我们的结果表明,在有扭转综合征风险的患者中使用芬太尼时,应考虑QTC延长效应.
BACKGROUND: Fentanyl is an opioid analgesic frequently used in the emergency department (ED) and is usually administered without knowing the QTC values of the patients or being monitored. However, the effect of fentanyl on QTC, prolongation or shortening, has not been elucidated. This study aimed to determine the effect of fentanyl on QTC.
METHODS: This is a prospective observational study in the ED of a tertiary hospital on patients who received intravenous fentanyl for procedures other than intubation. ECG was performed before and at 1, 5, 15, 30, and 60 min after the initiation of fentanyl administration, and QTC value was calculated. Primary outcomes were QTC prolongation, defined as an increase in the QTC to ≥ 500 ms or any increase in QTC by ≥ 60 ms.
RESULTS: The study included 109 patients. Of these, 60 patients were male, and the median age was 40. Compared with the baseline QTC value, statistically significant prolongation was detected at the 5th, 15th, 30th, and 60th minutes, with the maximum prolongation at 30 min, and the median was 13.08 ms. Most patients with QTC prolongation were female and over 40 years of age. Clinically, none of these patients developed malignant arrhythmias during the 60-minute monitored observation period.
CONCLUSIONS: Fentanyl prolonged the QTC value statistically significantly. Although no patient developed malignant arrhythmia clinically, our results suggest that this QTC-prolonging effect should be considered when using fentanyl in patients at risk of torsades.