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Лекарственно‑индуцированная атриовентрикулярная блокада

https://doi.org/10.33667/2078-5631-2020-19-56-64

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Аннотация

Атриовентрикулярные (АВ) блокады являются серьезным нарушением сердечного ритма. Одной из причин развития данной патологии может являться прием определенных лекарственных препаратов (ЛП). Таким эффектом обладает значительное число ЛП, используемых для лечения заболеваний сердечно-сосудистой системы, центральной нервной системы, общие и местные анестетики, противоопухолевые препараты и многие другие. Основным механизмом развития лекарственно-индуцированных АВ-блокад является ингибирование проводимости АВ-узла. Наиболее часто факторами риска развития лекарственно-индуцированных АВ-блокад являются прием двух и более ЛП, оказывающих ингибирующий эффект на АВ-проводимость, исходная продолжительность интервала PQ более 0,2 с, изначальная дисфункция АВ-узла, повышенная плазменная концентрация потенциального препарата-индуктора в связи с наличием заболевания почек и (или) печени, межлекарственные взаимодействия, также существуют и специфические факторы риска в отношении отдельных ЛП. Особое внимание в решении данной проблемы должно быть уделено как купированию развившегося нарушения АВ-проводимости – медикаментозному или же с использованием электрокардиостимулятора, так и его профилактике. В статье систематизированы литературные данные о лекарственно-индуцированных АВ-блокадах с целью повышения информированности практикующих врачей и пациентов об их распространенности, факторах риска, подходах к диагностике, лечению и профилактике.

Об авторах

М. И. Куликова
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России
Россия

ординатор кафедры клинической фармакологии и терапии

г. Москва



О. Д. Остроумова
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский университет)» Минздрава России
Россия

д.м.н., проф., зав. кафедрой терапии и полиморбидной патологии; проф. кафедры клинической фармакологии и пропедевтики внутренних болезней

г. Москва



А. Г. Комарова
ГБУЗ г. Москвы «Городская клиническая больница имени С.П. Боткина» Департамента здравоохранения г. Москвы
Россия
к.м.н., зам. гл. врача по медицинской части по региональному сосудистому центру


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Для цитирования:


Куликова М.И., Остроумова О.Д., Комарова А.Г. Лекарственно‑индуцированная атриовентрикулярная блокада. Медицинский алфавит. 2020;1(19):56-64. https://doi.org/10.33667/2078-5631-2020-19-56-64

For citation:


Kulikova M.I., Ostroumova O.D., Komarova A.G. Drug-induced atrioventricular blockages. Medical alphabet. 2020;1(19):56-64. (In Russ.) https://doi.org/10.33667/2078-5631-2020-19-56-64

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