- 期刊
Demographic Analysis of Dipyridamole-Induced Adverse Reaction in Patients Receiving Myocardial Perfusion Scans in Taiwan
台灣病人接受心肌灌注掃瞄使用Dipyridamole造成副作用的危險因子分析
摘要
背景：靜脈注射dipyridamole是一個常用來做心肌灌注掃瞄壓力相的藥物。各文獻報告的藥物副作用發生頻率差異很大，並且台灣族群的副作用發生頻率也少為被報告。目前也少有文獻廣泛的研究發生副作用的危險因子。這篇研究的目的是針對台灣接受心肌灌注掃瞄的病人在注射dipyridamole後副作用的發生率以及副作用發生的危險因子。方法：我們從2012年7月至2013年11月回顧性研究接受dipyridamole壓力心肌灌注掃瞄的成人病歷。病人檢查時的血壓、脈搏、心電圖、過去病史、身高、體重、年齡、性別、注射後的副作用、使用Aminophylline以及心導管檢查結果都會被紀錄。我們記錄個別副作用的發生頻率並且利用廣義線性模式來分析可能的危險因子。結果：總共有135位病人納入分析。總共有90（66.7%）個病人發生至少一項副作用。頭暈是最常見的副作用（52.6%），再來是頭痛（44.4%）以及胸痛（42.2%）。並共有19（14.1%）位病人需要提早使用Aminophylline緩解症狀。經過廣義線性模式分析後男性是與較少的副作用顯著的相關（β = -1.425, CI = -2.443 to -0.407, P = 0.006），而老年人呈現較少副作用的趨勢，呈邊緣顯著（β = -0.040, CI = -0.087 to 0.008, P = 0.099）。另外，針對Aminophylline使用的分析，12（17.6%）位女性需要提早使用Aminophylline來緩解症狀，而男性則有7（10.4%）位。常規使用與提早使用Aminophylline的平均年齡分別是66.2 ± 10.4歲以及61.3 ± 10.5歲（P = 0.057）。結論：台灣人接受dipyridamole壓力心肌灌注掃瞄的副作用頻率很高，女性以及年輕族群易發生較多的副作用， 並且較常需要提早給予Aminophylline。雖然dipyridamole很安全，然而在沒有禁忌症的情況下，仍可考慮避免在女性及年輕族群使用dipyridamole來執行壓力相。
並列摘要
Background: Intravenous dipyridamole is a commonly used stress method for myocardial perfusion scintigraphy. The reported frequency of adverse effects varied widely and the frequency of adverse effects in Taiwan population has not been investigated. In addition, no literature has extensively studied the risk factors of adverse effects after infusion of dipyridamole. The aim of this study is to investigate the frequency of adverse effects following infusion of dipyridamole for myocardial perfusion scintigraphy. Also, the demographic factors for developing adverse effects after dipyridamole infusion will be analyzed. Methods: We retrospectively reviewed the medical charts of adult patients received dipyridamole-stress myocardial perfusion scintigraphy from July 2012 till November 2013. The patient's blood pressure and pulse during the exam, electrocardiography report, past medical history, height, weight, age, gender, post-infusion adverse effects, early use of aminophylline and coronary angiography after the exam were recorded. We calculated the frequency of each adverse effect and analyzed the possible risk factors for developing more adverse effects by generalized linear model. Results: There were totally 135 patients enrolled. Among all the patients, 90 (66.7%) patients experienced at least one adverse effect. Dizziness was the most common adverse effect (52.6%), followed by headache (44.4%) and chest pain (42.2%). There were 19 (14.1%) patients required early aminophylline administration. After fitting generalized linear model, male was significantly correlated with less adverse effect (β = -1.425, CI = -2.443 to -0.407, P = 0.006) and old age showed a trend for less adverse effect with marginal significance (β = -0.040, CI = -0.087 to 0.008, P = 0.099). For the usage of aminophylline, there were 12 (17.6%) of female required early aminophylline injection and there were 7 (10.4%) male required early aminophylline use. The mean age for routine aminophylline administration and early aminophylline administration were 66.2 ± 10.4 and 61.3 ± 10.5 respectively (P = 0.057). Conclusion: The frequency of dipyridamole-induced adverse effect is not low in Taiwan. Female and younger patients are prone to develop more dipyridamole-induced discomforts and more frequently need early aminophylline administration. Although dipyridamole is still a safe stress method, alternative stress method can be suggested for female and younger patients to avoid or reduce their discomforts.