ВЛИЯНИЕ ОТДЕЛЬНЫХ ГРУПП ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ НА РИСК УДЛИНЕНИЯ ИНТЕРВАЛА QT

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Аннотация

Удлинение интервала QTC ассоциировано с повышенным риском развития жизнеугрожающих желудочковых аритмий (в том числе полиморфной желудочковой тахикардии, называемой также тахикардией типа «пируэт») и внезапной сердечной смерти. При этом одной из наиболее часто встречающихся причин развития приобретенного удлинения интервала QTC является воздействие тех или иных лекарственных средств. К настоящему времени практически все существующие фармакологические группы имеют представителей, обладающих QT-удлиняющим эффектом, реализация которого, особенно при сочетании с так называемыми факторами риска удлинения QTC (модифицируемыми: брадикардия, нарушения электролитного обмена, лекарственные взаимодействия, передозировка QT-удлиняющих лекарственных средств - и немодифицируемыми: женский пол, старший возраст, наследственная обусловленность, наличие структурной патологии сердца, заболевания печени и/или почек), приводит к развитию клинически значимых проявлений и осложнений, сопутствующих удлинению интервала QTC, в том числе фатальных. Наиболее выраженным QT-удлиняющим эффектом обладают представители групп антиаритмиков (IA, IC и III класса), антипсихотиков, антидепрессантов, антибиотиков (макролиды и фторхинолоны), антигистаминных средств, противоопухолевых и противогрибковых препаратов, прокинетиков, гиполипи-демических средств и диуретиков, исключая калийсберегающие. Осведомленность и адекватная оценка потенциальной QT-удлиняющей способности препарата, назначаемого пациенту, мониторирование и коррекция факторов, определяющих и повышающих риск лекарственно-обусловленного удлинения интервала QT, мониторирование электрокардиограммы, а также полная отмена всех препаратов, потенциально вызывающих удлинение интервала QT, при развитии лекарственно-индуцированного удлинения интервала QTC - важнейшие лечебно-профилактические мероприятия, позволяющие предотвратить или купировать аритмогенные эффекты лекарственных средств.

Об авторах

ОЛЬГА ДМИТРИЕВНА ОСТРОУМОВА

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России; ГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России

Email: ostroumova.olga@mail.ru
д-р мед. наук, проф., проф. каф. факультетской терапии и профболезней Москва, Россия

ИРИНА ВАСИЛЬЕВНА ГОЛОБОРОДОВА

ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России

канд. мед. наук, доц. каф. факультетской терапии и профболезней Москва, Россия

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