沙利度胺致心动过缓回顾性分析

Retrospective analysis of bradycardia induced by thalidomide

目的 分析沙利度胺致心动过缓的病例及其临床特点,为临床安全用药提供参考。方法 通过检索建库至2021年5月Web of Science、PubMed、Springer Link、CNKI、万方数据库和维普数据库,收集沙利度胺致心动过缓的个案报道,并对患者年龄、性别、合并基础疾病、沙利度胺用法用量、联合用药,以及心动过缓发生时间、临床特点及治疗转归等进行提取及统计分析。结果 沙利度胺致心动过缓的不良反应个案报道共13例,男9例(69.2%),女4例(30.8%),年龄23~76岁,>60岁的7例(7/13,占53.8%)。出现不良反应时,每日应用沙利度胺的总剂量为50~600 mg。出现心动过缓的时间,最短的为服药当天,最长的为用药后12个月,部分患者为逐渐加量过程中发生。13例患者中12例为症状性心动过缓,临床表现主要有胸闷、头晕、四肢无力、心悸、严重胸痛甚至晕厥,1例患者没有临床症状,仅心电图提示心动过缓。13例患者中有2例使用沙利度胺后心率低于40次/min, 8例为40~50次/min, 3例为50~60次/min。多数患者在停药、减量给予吸氧或阿托品对症处理后心率可以恢复正常,同时临床症状消失,少数患者需要应用临时起搏器进行紧急处理。结论 沙利度胺单用或与其他药物联用均可能导致心动过缓,应重点关注高风险人群,密切监测患者的临床症状,加强心电图等监护。

Objective To analyze the cases and characteristics of bradycardia caused by thalidomide and provide a reference for safety of clinical medication.Methods Web of Science,PubMed,Springer Link,CNKI,Wanfang and VIP database from database building till now were searched,the case reports on thalidomide-induced bradycardia were collected,and patients′age,sex,basic diseases,dosage of thalidomide,combined medication,the occurrence time of bradycardia,clinical manifestation and prognosis were analyzed statistically.Results A total of 13 cases of adverse reactions of bradycardia caused by thalidomide were reported,including 9 males(69.2%)and 4 females(30.8%),age ranging from 23 to 76 years old,and 7 cases(7/13,53.8%)over 60 years old.The total daily dose of thalidomide for adverse reactions ranged from 50 mg to 600 mg.The shortest time for the occurrence of bradycardia was the day of taking the drug and the longest was 12 months after taking the drug,and some patients had bradycardia during the course of increasing dose.Twelve of the 13 patients had symptomatic bradycardia,with the main clinical manifestations being chest tightness,dizziness,limb weakness,palpitations,severe chest pain and even syncope.One patient had no clinical symptom,and only ECG indicated bradycardia.Two of the 13 patients had heart rates below 40 beats/min after thalidomide use,8 had heart rates between 40 and 50 beats/min,and 3 had heart rates between 50 and 60 beats/min.The heart rate of most patients could return to normal after drug withdrawal and reducing the dose of oxygen or atropine symptomatic treatment,and at the same time,the clinical symptoms disappeared;a few patients needed to use temporary pacemaker for emergency treatment.Conclusion Thalidomide alone or in combination with other drugs may lead to bradycardia,so we should pay attention to high-risk groups,closely monitor the clinical symptoms of patients,and strengthen ECG monitoring.