Inhaled anticholinergic agent tiotropium is widely used in the treatment of chronic obstructive pulmonary disease（COPD）. However, it has pro-arrhythmic and pro-ischaemic effects, which can potentially increase the risk of serious cardiovascular events, especially in patients with pre-existing arrhythmias. We presented a 79-year-old man with a medical history of arrhythmia, who developed atrial fibrillation after used tiotropium 18 μg daily for two weeks. We urge the caution of pro-arrhythmic effect of tiotropium. Healthcare professionals should be aware of the potential effect when prescribing tiotropium to patients with known cardiac rhythm disorders.
This study aimed to investigate various regimens of antihypertensive agents for different groups of patients and the outcomes in the real world. We retrospectively collected 974 prescriptions for hypertension from three hospitals in Beijing, along with medical records of 219 hypertensive patients from one of the hospitals to study the regimens and their effects on patients. The antihypertensive regimens were classified by different combinations of subclasses of antihypertensive agents. Nearly all prescriptions can be classified into 11 different antihypertensive regimens, and most of them are combination therapy. Grade III hypertension patients significantly （P〈0.001） tend to be treated with regimens containing calcium channel blocker （CCB） and RAAS inhibitors, angiotensin II receptor blocker （ARB） or angiotensin-converting enzyme inhibitor （ACEI）. β-Blockers are more likely to be combined with CCB than with other categories of antihypertensive agents. Hydrochlorothiazide is less widely used than recommended.
目的:系统评价前列腺素E1(PGE1)联合水化预防造影剂肾病(CIN)的疗效和安全性,以为临床用药提供循证参考。方法:计算机检索Pub Med、Medline(Ovid)、EMBase(Ovid)、Cochrane图书馆、中文科技期刊全文数据库、中国期刊全文数据库、万方数据库,收集PGE1联合水化预防CIN的随机对照试验(RCT),提取数据和进行方法学质量评价后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入12项RCT,合计1 732例患者。Meta分析结果显示,试验组患者CIN发生率显著低于对照组[RR=0.40,95%CI(0.30,0.53),P<0.001],静脉炎发生率显著高于对照组[RR=10.18,95%CI(1.37,75.67),P=0.02],而肾脏替代治疗需求率与对照组比较差异无统计学意义[RR=0.44,95%CI(0.12,1.61),P=0.21]。结论:采用PGE1联合水化可以有效降低CIN发生率,但临床应注意患者静脉炎的发生。受纳入研究质量和研究样本的限制,该结论有待大样本、高质量的RCT进一步验证。
