摘要
1例8岁男性患儿因慢性肉芽肿病继发肺部感染反复发作,在美罗培南、复方磺胺甲噁唑和伏立康唑抗感染治疗基础上加用两性霉素B脂质体(剂量不详)。用药第3天,患儿出现心率加快、水肿、呼吸困难加重等,超声心动图示右心重度扩大及肺动脉高压。经强心、利尿及降肺动脉压等治疗半个月余,患儿肺部感染减轻,肺动脉压较前下降,但仍存在右心扩大。暂停治疗约半个月后,患儿因发绀、咳嗽加重,再次应用两性霉素B脂质体(初始剂量2 mg、1次/d并逐渐加量)联合哌拉西林钠他唑巴坦钠及复方磺胺甲噁唑抗感染治疗。用药第5天,应用两性霉素B脂质体50 mg后,患儿出现喘憋、面部浮肿,实验室检查示B型利钠肽(BNP)4679 ng/L,超声心动图示右心扩大及肺动脉高压。考虑患儿心脏扩张及心力衰竭与两性霉素B脂质体有关,停用该药,启用比阿培南、利奈唑胺联合伏立康唑抗感染治疗,并予强心、利尿等治疗。10 d后症状缓解,治疗方案更改为复方磺胺甲噁唑及伏立康唑。但3 d后,患儿再次出现腹胀、呼吸困难加重,行气管插管及呼吸机辅助通气,并予强心、利尿等治疗;根据肺泡灌洗液及痰培养结果,予头孢哌酮钠舒巴坦钠联合伏立康唑抗感染。治疗约1个月后,患儿症状改善,超声心动图示右心扩大消失、肺动脉压下降,BNP 800 ng/L。
An 8-year-old male patient with chronic granulomatous disease received amphotericin B liposome(unknown dose)in addition to anti-infection treatments with meropenem,compound sulfamethoxazole,and voriconazole due to recurrence of secondary pulmonary infection.After 3 days,the patient developed tachycardia,edema,and worsening dyspnea.Echocardiography revealed severe right heart enlarge-ment and pulmonary hypertension.Cardiotonic,diuretic,and pulmonary antihypertensive therapies were given.After over half a month,his pulmonary infection was improved,pulmonary arterial pressure decreased,but the right heart enlargement persisted.Suspending treatment about half a month later,amphotericin B liposome was reinitiated at a gradually increased dose from 2 mg once daily,in combination with piperacillin sodium and tazobactam sodium and compound sulfamethoxazole due to aggravated cyanosis and cough.After the administration of amphotericin B liposome(50 mg once daily)on day 5,the patient experienced wheezing and facial edema.Laboratory tests showed B-type natriuretic peptide(BNP)4679 ng/L;echocardiography demonstrated right heart enlargement and pulmonary hypertension.Suspecting that the cardiac dilatation and heart failure were associated with amphotericin B liposome,the drug was discontinued.The anti-infection regimen was switched to biapenem,linezolid and voriconazole,along with continued cardiotonic and diuretic managements.The patient's symptoms were improved after 10 days,the treatment regimen was changed to compound sulfamethoxazole and voriconazole.However,after 3 days,the patient's abdominal distension and dyspnea worsened.Endotracheal intubation and mechanical ventilation were initiated along with cardiotonic and diuretic therapy;anti-infection therapy with cefoperazone sodium and sulbactam sodium combined with voriconazole was given based on bronchoalveolar lavage fluid and sputum culture results.One month later,the patient's condition was improved,showing no right ventricular dilation and reduced pulmonary arterial pressure on echocardiography and BNP 800 ng/L.
作者
代恩鹏
陈源
杨士斌
王盼
田亚
Dai Enpeng;Chen Yuan;Yang Shibin;Wang Pan;Tian Ya(Department of Pediatrics,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)
出处
《药物不良反应杂志》
2025年第11期699-702,共4页
Adverse Drug Reactions Journal
关键词
两性霉素B
肉芽肿病
慢性
肺动脉高压
心力衰竭
心脏扩张
Amphotericin B
Granulomatous disease,chronic
Pulmonary arterial hypertension
Heart failure
Cardiac dilatation
