腺苷注射液转复阵发性室上性心动过速有效性及安全性的循证药学评价  

Evidence-based evaluation of the efficacy and safety of adenosine injection in paroxysmal supraventricular tachycardia

作　　者：郑子恢[1] 高峰 赵紫楠[1] 张伟伟 金鹏飞[1] ZHENG Zihui;GAO Feng;ZHAO Zinan;ZHANG Weiwei;JIN Pengfei(Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application(Beijing Hospital),Beijing 100730,China;Depatment.of Health Service,the Guard Bureau of the Joint Staff Department,Central Military Commission,People's Republic of China,Beijing 100017,China;Department of Rehabilitation Pharmacy Center,Beijing Rehabilitation Hospital of Capital Medical University,Beijing 100144,China)

机构地区：[1]北京医院药学部、国家老年医学中心、中国医学科学院老年医学研究院、北京市药物临床风险与个体化应用评价重点实验室(北京医院),北京100730 [2]中央军委联合参谋部警卫局卫生保健处,北京100017 [3]首都医科大学附属北京康复医院康复药学中心,北京100144

出　　处：《临床药物治疗杂志》2024年第7期56-63,共8页Clinical Medication Journal

基　　金：国家重点研发计划(2020YFC2009001)。

摘　　要：目的系统评价腺苷注射液转复阵发性室上性心动过速(PSVT)的有效性及安全性。方法计算机检索PubMed、Embase、the Cochrane Library、中国知网、万方数据知识服务平台、中国生物医学文献数据库,中文数据库收集从建库至2024年1月中国科技核心期刊发表的腺苷注射液转复PSVT的RCT及不同剂量的单臂试验(SAT),英文数据库不做期刊限制。纳入的RCTs及SATs分别使用RevMan 5.4及Stata 15.1软件对腺苷注射液转复PSVT的有效性及安全性进行meta分析。结果共纳入26项研究,包括8项RCTs及18项SATs。转复成功率方面,腺苷注射液略高于其他阳性药物,且转复成功率与剂量有关,腺苷注射液在终止PSVT的整体转复成功率为0.91(95%CI:0.86~0.95),其中有34%的PSVT患者使用剂量到3 mg时可有效终止PSVT的发生,60%的PSVT患者使用剂量到6 mg时可有效终止PSVT的发生,49%的PSVT患者使用剂量到9 mg时可有效终止PSVT的发生,23%的PSVT患者使用剂量到12 mg时可有效终止PSVT的发生,4%的PSVT患者使用剂量到15 mg时可有效终止PSVT的发生,9%的PSVT患者使用剂量到18~30 mg时可有效终止PSVT的发生;转复成功时间方面,相比其他非腺苷类阳性药物,腺苷具有明显的优势,且差异有统计学意义(P<0.05);安全性方面,腺苷组不良反应发生率略低于其他阳性药物,但差异无统计学意义(RR=0.80,95%CI:0.62~1.03,P>0.05)。结论腺苷注射液可有效转复PSVT,6 mg剂量下的腺苷对终止PSVT的有效率显著提高,有效剂量主要集中在6~12 mg,且安全性良好。Objective To evaluate the efficacy and safety of adenosine injection for cardioversion of paroxysmal supraventricular tachycardia(PSVT).Methods We conducted a computer-based search in PubMed,Embase,the Cochrane Library,CNKI,Wanfang database,and the Chinese Biomedical Literature database to collect RCT and single-arm trial(SAT)published in the core journals of Chinese science and technology papers from the establishment of the databases to January 2024.These trials evaluated the use of adenosine injection in the conversion of PSVT,and RCTs and SATs were analyzed separately using RevMan 5.4 and Stata 15.1 software for meta-analysis.For the English databases,no journal restrictions were applied.Results A total of 26 studies were included,comprising 8 RCTs and 18 SATs.In terms of conversion success rate,adenosine injection doses ranged were slightly higher than those of other positive drugs,and the success rate was doserelated.The overall conversion success rate of adenosine injection in terminating PSVT was 0.91(95%CI:0.86 to 0.95).Among these patients,34% patients effectively terminated PSVT at the dosage of 3 mg,60% at the dosage of 6 mg,49% at the dosage of 9 mg,23% at the dosage of 12 mg,4% at the dosage of 15 mg,and 9% at the dosage ranged from 18 mg to 30 mg.In terms of conversion success time,adenosine had a significant advantage compared to other non-adenosine-positive drugs,and the difference was statistically significant(P<0.05).Regarding safety,the incidence of adverse reactions in the adenosine group was slightly lower than that in other positive drug groups,but the difference was not statistically significant(RR=0.80,95%CI:0.62 to 1.03,P>0.05).Conclusion Adenosine injection is an effective treatment for the treatment of PSVT,and the effectiveness of adenosine at the dosage of 6 mg in terminating PSVT is significantly improved.The recommended dosage of adenosine typically ranges from 6 mg to 12 mg with good safety.

关 键 词：腺苷注射液 阵发性室上性心动过速 循证药学 META分析 

分 类 号：R972[医药卫生—药品] R541.7[医药卫生—药学]