万古霉素致肾衰竭死亡2例  

Death from renal failure caused by vancomycin in 2 patients

作　　者：鱼爱和[1] 聂昭华[2] 孙光[2] 刘莉[2] 许冬联[2] 陈光恒[1] 

机构地区：[1]解放军第261医院药剂科,北京100094 [2]解放军第261医院呼吸科,北京100094

出　　处：《药物不良反应杂志》2008年第3期205-206,共2页Adverse Drug Reactions Journal

摘　　要：2例精神病患者因肺部感染静脉滴注万古霉素致肾衰竭死亡。例1为84岁男性精神病患者,因肺部感染和呼吸衰竭行气管切开。给予患者糖皮质激素、头孢他啶及依替米星治疗,后改为万古霉素1g,2次/d,静脉滴注。患者的Cr和BUN水平用药前为分别为71μmol/L和7.3mmol/L;治疗第9天分别升至223μmol/L和27.3mmol/L。患者尿量由1930ml(治疗第6天)减少至650ml(治疗第8天)。患者出现肺栓塞、急性肾衰竭、代谢性酸中毒、心律失常及浅昏迷,最后经抢救无效死亡。例2为58岁女性精神病患者,因肺部感染给予头孢吡肟、亚胺培南-西司他丁及低分子肝素钙,后改为万古霉素1g,2次/d,静脉滴注。患者的Cr和BUN水平用药前分别为87μmol/L和7.5mmol/L,用药第3天分别升至124μmol/L和14.7mmol/L,用药第6天分别升至436μmol/L和30.1mmol/L。患者尿量自用药第3天下降至900ml,用药第6天下降至200ml,并出现腹泻。诊断为急性肾衰竭,停用万古霉素,经抢救无效,于停用万古霉素第3天死亡。Two patients with mental disorders died from renal failure following intravenous infusion of vancomycin for treating pulmonary infection. The first patient, an 84-year-old man with mental disorders, underwent tracheotomy due to his pulmonary iniection and respiratory failure. Initially, the glucocorticosteroids, ceftazidime, and etimicin were given to the patient, and subsequently changed to intravenous infusion of vancomycin 1 g twice daily. His Cr and BUN levels were 71 ~mol/L and 7.3 mmol/L before vancomycin therapy, respectively, and increased to 223 μmol/L and 27.3 mmol/L on the day 9 of treatment, respectively. His urine volume decreased from 1 930 ml （ on day 6 of treatment） to 650 ml （ on day 8 of treatment）. He developed pulmonary embolism, acute renal failure, metabolic acidosis, cardiac arrhythmia, and mild coma. Despite continuous resuscitation efforts, he died. The second patient, a 58-year-old woman with mental disorders, was initially given cefepime, imipenem-cilastatin, and low molecular heparin calcium, and subsequently changed to intravenous infusion of vancomycin 1.0 g twice daily for pulmonary infection. Her Cr and BUN levels were 87 txmol/L and 7.5 mmol/L before vancomycin therapy, respectively, and increased to 124 txmol/L and 14.7 mmol/L on day 3 of vancomycin therapy, respectively; and 436 txmol/L and 30.1 mmol/L on day 6 of vancomycin therapy, respectively. Her urine volume decreased to 900 ml on day 3 of vanconmcin therapy, and to 200 ml on day 6 of vancomycin therapy. She developed diarrhea. Acute renal failure was diagnosed. Vancomycin was discontinued. Despite continuous resuscitation efforts, she died on day 3 after vancomycin discontinuation.

关 键 词：万古霉素 肾衰竭 

分 类 号：R595.3[医药卫生—内科学]