摘要
1例77岁男性患者,因"咳嗽、咳痰3 d,发热1 d"入院,诊断为"肺部感染、房颤"。入院检查心电图示QTc 528 ms,血钾浓度3.1 mmol·L^(-1),给予头孢他啶联合左氧氟沙星抗感染治疗,补钾、华法林抗凝治疗。之后CT提示感染加重,心电图示QTc 662 ms,考虑喹诺酮类可能致QTc延长,药师不建议继续使用喹诺酮类药物,升级抗菌药物为亚胺培南西司他丁联合多西环素,使用甲泼尼龙抗炎,同时补钾补镁。之后患者出现外周血白细胞升高,但CRP下降、症状好转,考虑感染减轻,抗菌药物降阶梯为多西环素,停用激素。之后出现INR升高,将华法林减量,未见出血。患者输注多西环素后局部疼痛,考虑为静脉炎,更换为头孢美唑后逐渐缓解。后复查CT示感染好转,心电图示QTc 483 ms。
A 77-year-old male patient was hospitalized because of cough and expectoration for 3 days, fever for 1 day, and he was diagnosed as pulmonary infection and atrial fibrillation. The QTc interval was 528 ms showed by electrocardiogram, and the blood potassium concentration was 3.1 mmol·L^-1. The patient was treated with ceftazidime combined with levofloxacin for anti-infective therapy, potassium supplement, and warfarin for anticoagulant therapy. After that, CT showed that the infection was aggravated, and electrocardiogram showed that the QTc was 662 ms. The QTc interval prolongation was considered as the adverse reaction of quinolones. So the pharmacists did not recommend continuing using quinolones, and suggested upgrading the antibacterials to imipenem cilastatin sodium combined with doxycycline, using methylprednisolone for anti-inflammation, as well as supplementing potassium and magnesium. After that, WBC in peripheral blood increased, while the CRP decreased and the symptoms relieved. Considering the alleviation of infection, the antimicrobial drugs were reduced to doxycycline and the methylprednisolone was discontinued. After that, INR increased and the dose of warfarin was reduced without bleeding. Local pain after doxycycline infusion was considered as phlebitis, and this symptom gradually relieved after doxycycline switching to cefmetazole. Afterwards CT showed that the infection was improved, and electrocardiogram showed that QTc interval was 483 ms.
作者
刘慧敏
郑芳
李鹏
陈富超
李聪
李志浩
李春雷
LIU Hui-min;ZHENG Fang;LI Peng;CHEN Fu-chao;LI Cong;LI Zhi-hao;LI Chun-lei(Department of Pharmacy, Dongfeng Hospital Affiliated to Hubei University of Medicine, Shiyan 442008, China)
出处
《中国药物应用与监测》
CAS
2019年第1期21-24,共4页
Chinese Journal of Drug Application and Monitoring
基金
十堰市科技局引导性项目(18Y85)
关键词
房颤
肺部感染
药品不良反应
药学监护
Atrial fibrillation
Pulmonary infection
Adverse drug reaction
Pharmaceutical care
