5-羟色胺3受体拮抗剂相关心脏毒性文献病例分析  

Literature case analysis of cardiotoxicity due to 5-HT3 receptor antagonists

作　　者：纪文 王书平 汤振国 张文 Ji Wen;Wang Shuping;Tang Zhenguo;Zhang Wen(Department of Pharmacy,Jiaozhou Central Hospital of Qingdao,Shandong Province,Qingdao 266300,China;Department of Pharmacy,Laiwu People’s Hospital of Ji’nan,Ji’nan 271100,China;Department of Pharmacy,Zibo Central Hospital,Shandong Province,Zibo 250036,China;Department of Pharmacy,Shandong Provincial Hospital Affiliated to Shandong University,Ji’nan 250021,China)

机构地区：[1]青岛市胶州中心医院药学部,青岛266300 [2]济南市莱芜人民医院药剂科,济南271100 [3]淄博市中心医院药学部,淄博250036 [4]山东第一医科大学附属省立医院药学部,济南250021

出　　处：《药物不良反应杂志》2024年第4期204-210,共7页Adverse Drug Reactions Journal

基　　金：科技部国家重点研发计划(2020YFC2008902)。

摘　　要：目的探讨5-羟色胺3(5-HT3)受体拮抗剂相关心脏毒性的临床特点。方法检索国内外有关数据库(截至2023年6月20日),收集5-HT3受体拮抗剂致心脏毒性的病例报告文献,提取患者相关信息、用药情况(药品名称、用法用量、用药指征、联用药物)、心脏毒性发生情况、5-HT3受体拮抗剂与心脏毒性的关联性评价、干预措施及转归,进行描述性统计分析。结果纳入分析的病例报告共23篇,其中英文文献22篇,中文文献1篇;涉及患者26例,包括男性6例、女性20例;年龄8~60岁,平均年龄40岁;用药原因为围手术期止吐19例,化疗止吐2例,其他原因5例;使用昂丹司琼者19例,多拉司琼4例,格拉司琼、托烷司琼和帕洛诺司琼各1例;除1例自行过量服用外,25例患者的用药剂量均在说明书推荐范围内。26例患者共发生心脏毒性50例次,主要为心动过速(12例次)、心电图改变(11例次)、心动过缓(9例次)、心搏骤停和心肌梗死(各1例次)等。21例患者心脏毒性反应发生在初次用药后,其中8例发生于初次用药后即刻,5例发生于≥2次用药后。出现心脏毒性后,26例患者均停用5-HT3受体拮抗剂,其中24例立即停药并给予对症治疗,1例8 d后停药未予其他干预,1例用药至症状加重后停药并进行对症治疗。经停药和/或对症治疗后,25例患者的前述症状消失、心电图恢复正常,其中22例恢复时间≤48 h,另3例分别在1周、2周及2个月时心电图恢复正常;1例因心室颤动治疗无效死亡。结论5-HT3受体拮抗剂所致心脏毒性多发生在初次用药后,主要表现为心动过速、心动过缓、心电图改变等;及时停药并对症治疗后大部分患者预后良好,但严重者可导致死亡。Objective To explore the clinical characteristics of cardiotoxicity due to 5-hydroxytryptamine 3 receptor(5-HT3)antagonists.Methods Relevant databases at home and abroad(up to June 20,2023)were searched and case literature of cardiotoxicity induced by 5-HT3 receptor antagonist were collected.Relevant information of patients,medication status(drug name,usage and dosage,indication,combined drugs),occurrence of cardiotoxicity,evaluation of the association between 5-HT3 receptor antagonists and cardiotoxicity,intervention measures and outcomes were extracted and analyzed descriptively and statistically.Results A total of 23 case reports,22 in English and 1 in Chinese,were enrolled in the analysis.There were 26 patients,6 males and 20 females,and the age ranged from 8 to 60 years,with an average of 40 years.The reasons for drug use were perioperative antiemesis in 19 patients,chemotherapy antiemesis in 2 patients,and other reasons in 5 patients.Ondansetron was used in 19 patients,dolasetron in 4 patients,granisetron,tropisetron and palonosetron in 1 patient each.Except for 1 patient with overdose by self-medication,the dosage in 25 patients was within the recommended range in labels.A total of 50 case time of cardiotoxicity occurred in 26 patients,mainly including tachycardia(12 cases),electrocardiogram(ECC)changes(11 cases),bradycardia(9 cases),cardiac arrest(1 case),and myocardial infarction(1 case),etc.Twenty-one patients experienced cardiotoxicity after initial medication,of which 8 occurred immediately after the initial medication,5 patients occurred after≥2 times of medication.After the occurrence of cardiotoxicity,26 patients stopped 5-HT3 receptor antagonists successively,of which 24 stopped the drug immedia-tely and received symptomatic treatments,1 stopped the drug after 8 days of medication without other intervention,and 1 stopped the drug and received symptomatic treatment after the symptoms aggravated.After drug withdrawal and/or symptomatic treatments,the mentioned symptoms disappeared and ECC returned

关 键 词：止吐药 受体 血清素 5-HT3 药物相关副作用和不良反应 心脏毒性 昂丹司琼 多拉司琼 格拉司琼 托烷司琼 帕洛诺司琼 

分 类 号：R969.3[医药卫生—药理学] G353.1[医药卫生—药学]