A 53-year-old man with is admitted to the ICU after a Whipple procedure

答案:A 。

解析:Prolongation(延长) of the QT interval can be congenital(先天性的) or acquired by drug administration. This may be the result of the drug itself or the inhibition(抑制) of metabolic pathways that will increase the effective dose of the drug. A QTc greater than 500 ms is a prolonged QT that may result in torsades de pointes (TdP)(尖端扭转综合征) and possibly sudden death. Repletion of magnesium(镁) is useful for the prevention and treatment of TdP, and removal of any agent that may prolong the QTc is optimal(最佳). Amiodarone(胺碘酮) would be harmful because it could actually lower the heart rate and increase the QT interval. Bicarbonate has no role in QTc prolongation. Methadone could lead to prolonged QT syndrome and should be discontinued.

来源于SCCM, Self-Assessment in Adult Multiprofessional Critical Care 8th Edition

参考文献:

  1. Armahizer MJ, Seybert AL, Smithburger PL, Kane-Gill SL. Drug-drug interactions contributing to QT prolongation in cardiac intensive care units. J Crit Care. 2013 Jun;28(3):243-249.
  2. Beitland S, Platou ES, Sunde K. Drug-induced long QT syndrome and fatal arrhythmias in the intensive care unit. Acta Anaesthesiol Scand. 2014 Mar;58(3):266-272.
  3. Charbit B, Albaladejo P, Funck-Brentano C, Legrand M, Samain E, Marty J. Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology. 2005 Jun;102(6):1094-1100.

根据上述文献,尖端扭转的心律失常可能的药物有:

A 53-year-old man with is admitted to the ICU after a Whipple procedure

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