应用血管紧张素转换酶抑制剂不良反应的特征分析

摘要

目的 分析应用血管紧张素转换酶抑制剂(ACEI)的不良反应特征.方法 选取高邮中医医院心内科于2011年5月～2016年5月收治的应用ACEI治疗后发生不良反应的患者412例,其中男性243例,女性169例,年龄18～75岁,平均(52.5±4.9)岁.回顾性分析入组患者的年龄、用药情况、不良反应表现、发生时间、治疗情况等.结果 本组患者中,年龄<30岁和30～39岁比例较小,主要分布在40～49岁、50～59岁、60～69岁、≥70岁.卡托普利致不良反应的比例最高,为77.91％;其次为贝那普利与依那普利分别为8.74％、7.04％;雷米普利、福辛普利、培哚普利、赖诺普利致不良反应比例较低,分别为2.91％、1.46％、1.46％和0.49％.ACEI不良反应的临床表现以喘憋、咳嗽、咽部不适为主,主要累及呼吸系统,占65.05％;7.77％的患者不良反应累及皮肤,临床表现为皮疹、水肿、炎症、溃疡等;7.77％累及泌尿生殖系统,有尿频、蛋白尿、血尿等表现.另外还有7.04％累及心血管系统,4.85％累及血液系统,4.85％累及消化系统,2.18％累及关节肌肉.412例患者中,26例在用药当天即出现不良反应,占6.31％,386例在用药第2 d后出现不良反应,占93.69％,不良反应的平均出现时间为(16.9±10.4)d.患者经对症治疗或停药处理后,绝大多数症状明显缓解并逐渐消失,其中30例患者复用药物后再次发生相同不良反应.结论 应用ACEI发生的不良反应表现多样、原因复杂,多数需对症治疗或停药才可消失,临床用药过程中要密切监测不良反应,提高用药安全性.%Objective To analyze the features of adverse reactions after treatment with angiotensin converting enzyme inhibitor (ACEI).Methods The patients (n=412, male 243, female 169, aged from 18 to 75 and average age=52.5±4.9) with adverse reactions after treatment with ACEI were chosen from the Department of Cardiology in Gaoyou Hospital of Chinese Medicine from May 2011 to May 2016. The age, drug administration, manifestations and occurrence time of adverse reactions and treatment conditions were retrospectively analyzed in all patients.Results The percentages of patients aged<30 and from 30 to 39 were lower, and patients' ages mainly distributed from 40 to 49, 50 to 59, 60 to 69 and over 70. The proportion of adverse reactions induced by captopril was the highest (77.91％), and that by benazepril was 8.74％ and by enalapril was 7.04％. The proportions of adverse reactions induced by ramipril (2.91％), fosinopril (1.46％), perindopril (1.46％) and lisinopril (0.49％) were lower. The clinical manifestations of adverse reactions induced by ACEI were mainly wheezing, coughing and throat discomfort, and mainly involved the respiratory system, accounting for 65.05％. The adverse reactions involved skin in 7.77％ of patients, and clinical manifestations included rash, edema, inflammation and ulcer. The adverse reactions involved the urogenital system in 7.77％ of patients, and clinical manifestations included frequent urination, proteinuria and hematuresis, and involved the cardiovascular system in 7.04％ of patients, blood system in 4.85％, digestive system in 4.85％, and joints and muscle in 2.18％. Among 412 patients, there were 26 (6.31％) with adverse reactions at medication day and 386 (93.69％) with adverse reactions after 2 d, and the average time was (16.9±10.4) d. The symptoms of adverse reactions were relieved and disappeared in the most of patients after treatment or stopping medication, while there were 30 patients had the same adverse reactions after re-medication. Conclusion The manifestations of adverse reactions induced by ACEI are multiple and causes are complex, which will disappear after symptomatic treatment or stopping medication. The adverse reactions should be closely monitored in clinic for improving safety of medication.