某醫學中心對使用Amiodarone病患執行安全監測之評估

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题名:	某醫學中心對使用Amiodarone病患執行安全監測之評估
作者:	陳玉美;羅美婷:賴永融;李建瑩
关键词:	amidarone;安全性監測;基礎值
日期:	2011
上传时间:	2019-08-15T08:03:43Z (UTC)
出版者:	社團法人臺灣臨床藥學會
ISSN:	1027-5096
摘要:	目的：Amiodarone為一有效抗心律不整藥物，然而，使用時會伴隨廣泛性之不良反應，給予病患適當的後續追蹤監控，以防止不良反應造成的傷害是相當重要的。本研究目的是為確定使用amiodarone治療之病人於開始及持續過程是否接受適當之監測。方法：本研究採回溯性分析，以電子病歷審視，收集2005年7月到2006年6月期間開始服用amiodarone之成年門診病患。記錄病患基本資料(性別、年齡)、病史，使用之原因、開始服用日期、服用時間及劑量。依據NASPE於2000年所發表之使用方針做評估。針對相關之不良反應，記錄監測病患肝功能、甲狀腺功能(T4和TSH)、胸部X-光攝影及肺功能測試(包括DLCO，carbon monoxide diffusing capacity)。結果：2005年7月至2006年6月間開始服用amiodarone之病人數有336人，包括男性203人，女性133人。年齡分距：≧65歲有214人，＜65歲有122人。首次處方醫師為心臟內科者257人，心臟外科者25人。服用期間大於1年者有86人，少於6個月者250人。336人中首次使用amiodarone前進行肝功能基礎值監測有138(41.1%)，甲狀腺功能基礎值監測有24(7.2%)，胸部X光攝影有191人(56.8%)，肺功能評估皆為0人。服用期間大於1年之86人中首次使用前及使用中進行肝功能基礎值監測有86人(100%)、22人(26%)；甲狀腺功能基礎值監測有6人(7%)、18人(21%)；胸部X光攝影有44人(51.2%)、20人(23%)。結論：目前於使用amiodarone治療時，進行肝功能、甲狀腺功能及肺部功能之監測比例仍不合理想，藥師可經建構適當之機制以推動醫師了解監測之重要性。 Objectives Amiodarone is an effective antiarrhythmic agent with extended side-effects. It is therefore necessary to arrange appropriate, serial monitoring to prevent adverse effects. The purpose of this study was to quantify adherence to published recommendations for baseline monitoring when initiating amiodarone therapy and determine whether appropriate serial monitoring of chronic amiodarone therapy is occurring. Methods A retrospective review of electronic medical records was conducted for outpatients who started amiodarone therapy at Chung Shan Medical University Hospital between July 1, 2005 and June 30, 2006. Their medical records were reviewed for demographic data reasons for, date of initiation of, and duration of amiodarone therapy and the occurrence of laboratory and diagnostic tests. The amiodarone guidelines from the North American Society of Pacing and Electrophysiology (NASPE) were used as the measure of appropriate monitoring for baseline and follow-up chest x-rays (CXRs), liver function tests (LFTs), thyroid function tests (TFTs), and pulmonary function tests (PFTs). Results Over the 1-year period from July 1, 2005 through June 30, 2006, 336 adult patients received amiodarone at Chung shan Medical University Hospital. These patients received baseline CXR, LFT , and TFT assessments were 57%, 41% and 7% respectively. However, none of the patients received baseline PFT assessments (diffusion lung capacity for carbon monoxide). Eighty-six(26%) patients received chronic amiodarone therapy for over one year. Baseline LFT, TFT, and CXR assessments occurred in 100%, 6% and 44% of these patients, respectively, and baseline PFT assessments were not performed in any of the patients. Follow-up monitoring at the recommended time intervals for LFTs and TFTs occurred in 22% and 18% of all of the patients, respectively, whereas annual CXRs were performed appropriately in 20% of the patients. Conclusions Our data suggest that opportunities exist for improved monitoring of amiodarone therapy according to the NASPE guidelines and provide support for the development of a protocol to ensure continuous amiodarone monitoring and safety of amiodarone therapy.
URI:	https://ir.csmu.edu.tw:8080/ir/handle/310902500/20314
關聯:	台灣臨床藥學雜誌, vol. 19, issue 4, 1-10
显示于类别:	[醫學系] 期刊論文

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