瑞德西韦相关性心动过缓的文献病例分析

Literature Case Analysis of Remdesivir-Related Bradyarrhythmia

目的 探讨瑞德西韦相关性心动过缓的发生情况和特点,为临床安全用药提供参考。方法 检索PubMed、Embase、中国知网、万方和维普数据库自建库至2023年10月收录的瑞德西韦相关性心动过缓的病例报道并对其进行整理分析。结果 共纳入23篇文献共计32例患者,男性16例(50.0%),女性14例(43.8%),年龄3个月~80岁,平均(43.1±23.5)岁。27例(84.4%)患者在用药后3 d内发生心动过缓。发生心动过缓时患者心率较基线降幅25.0%~76.0%,其中有20例(62.5%)表现为严重心动过缓。经停药或继续治疗以及予以阿托品或心脏起搏等对症处理后,除2例(6.3%)最终死于原发疾病恶化外,其余患者均转归良好。结论 临床在使用瑞德西韦期间尤其是用药后的前3 d内应加强对患者心率的监测,一旦发现心动过缓应综合考虑患者病情决定是否停用瑞德西韦,必要时可予以阿托品或心脏起搏等治疗。

OBJECTIVE To explore the occurrence and characteristics of remdesivir-related bradyarrhythmia and provide references for clinical safe drug use.METHODS The case reports of remdesivir-related bradyarrhythmia published in PubMed,Embase,CNKI,Wanfang and VIP were searched from the establishment of each database to October 2023,and statistical analysis was conducted on relevant information and data.RESULTS A total of 32 cases from 23 articles were identified and included in the analysis.There were 16 males(50.0%) and 14 females(43.8%),aged from 3 months to 80 years,with an average age of(43.1±23.5) years.Twenty-seven patients(84.4%) experienced bradyarrhythmia within 3 days after medication.When bradyarrhythmia occurred,the heart rate decreased by 25.0% to 76.0% from baseline,and 20 patients(62.5%) presented with severe bradyarrhythmia.After withdrawal or continuation of treatment and symptomatic management such as atropine or cardiac pacing,all patients had a good outcome except for 2 cases(6.3%) who eventually died from exacerbation of the primary disease.CONCLUSIONS Clinical monitoring of the patient′s heart rate should be strengthened during the use of remdesivir,especially in the first 3 days after medication.Once bradyarrhythmia is found,the patient′s condition should be comprehensively considered to decide whether to stop remdesivir,and atropine or cardiac pacing can be inserted if necessary.