新型冠状病毒肺炎防治中药源性心脏损伤的药物警戒研究

Pharmacovigilance study on drug-induced cardiac injury during treatment of COVID-19

由新型冠状病毒引起的肺炎具有强传染性和传播力,已在全球范围内对公共卫生造成重大威胁。中西医结合治疗该疾病的疗效获到了普遍的肯定,但值得注意的是,相关药物在临床使用中可能会引起药源性心脏损伤,需引起临床工作者的关注。该文依据《新型冠状病毒肺炎诊疗方案(试行第七版)》的指导意见,以推荐用药为例,从西药、单味中药、中药注射剂以及中西药联用等角度,采用文献综述及生物信息学等方法对联合用药、心脏相关不良反应、特殊人群、说明书禁忌、用药监护等环节进行综述,重点阐述其引起药源性心脏损伤的临床表现、毒性成分、作用靶点与调控机制等。该文建议在临床治疗新型冠状病毒肺炎过程中应警惕药源性心脏损伤,发挥临床药师及临床中药师的优势,提升药物警戒知识储备,加强处方审核、用药告知与用药监护,促进合理用药,关注特殊人群与高危人群,以期为一线抗疫的临床医生与药师提供药物警戒与药学监护的科学依据与参考,避免新型冠状病毒肺炎患者药源性心脏损伤的发生。

Because coronavirus disease 2019(COVID-19) is highly contagious and serious, it has posed a major threat to public health worldwide. The curative effects of integrated traditional Chinese medicine and Western medicine in the treatment of COVID-19 have been widely recognized and confirmed. However, medical workers shall pay attention to drug-induced heart injury in clinical application. Based on the guideline from the Diagnosis and Treatment Plans for COVID-19(trial seventh edition), taking the recommended drugs as examples, by Western medicine, traditional Chinese medicine, Chinese herbal injection and integrated traditional Chinese and Western medicine, the study analyzed the basic characteristics of recommended drugs for cardiac injury by means of literature review and bioinformatics methods, and summarized cardiac adverse reactions, toxicity mechanisms, combined pharmacotherapy, special population and drug monitoring, focusing on the clinical manifestations, toxic components, targets and regulatory mechanisms of drug-induced cardiac injury. The findings suggested being vigilant to drug-induced cardiac injury during the treatment of COVID-19, playing the advantages of clinical pharmacists and clinical Chinese pharmacists, improving the knowledge reserve of pharmacovigilance, strengthening the prescription review, medication notification and medication monitoring, promoting rational drug use and paying attention to special populations and high-risk groups. The study aims to provide suggestions and reference for pharmacovigilance and pharmaceutical care for front-line doctors and pharmacists against COVID-19, in order to avoid the occurrence of drug-induced heart injury for patients with COVID-19.