那屈肝素钙致消化道出血及腹部血肿  

Gastrointestinal hemorrhage and abdominal hematoma caused by nadroparin calcium

作　　者：孙丽杰[1] 刘书旺[1] 陈宝霞[1] 张永珍[1] 高炜[1] 

机构地区：[1]北京大学第三医院心内科,北京100191

出　　处：《药物不良反应杂志》2010年第5期348-349,共2页Adverse Drug Reactions Journal

摘　　要：1例77岁男性患者,因拟行射频消融术,术前给予预防性抗凝治疗,皮下注射那屈肝素钙6150U,1次/12h。2d后患者出现晨起头晕、晕厥、腹痛,腹部可触及包块。停用那屈肝素钙。之后患者呕吐咖啡样胃内容物约200mL,BP80/50mmHg,HR110次/min。CT检查示腹部肿块。次日左侧腰腹部出现瘀斑,腹部包块明显增大,张力增高,触痛明显。Hb74g/L。腹部超声检查:肝周、肾周、脾周及腹腔存在少量积液。那屈肝素钙停用48h后Hb80g/L。随后给予对症支持治疗,上述症状逐渐好转。停用4d后开始进流食,未再发生消化道出血。停用4周后Hb120g/L,随访8个月病情稳定。A 77-year-old man underwent subcutaneous injection of nadroparin calcium 6 150 U every 12 hours as preventive anticoagulation treatment before radiofrequency catheter ablation.Two days later,the patient developed dizziness,faint,abdominal pain,and a palpable mass in his abdomen.Nadroparin calcium was withdrawn.Subsequently,he vomited coffee-ground-like gastric content 200 mL,and his blood pressure and heart rate were 80/50 mm Hg and 110 beats/min,respectively.CT showed abdominal masses.The next day,he experienced ecchymosis at the left lumbo-abdominal site and a markedly enlarged abdominal mass with elevated tension and obvious tenderness.His hemoglobin was 74 g/L.Abdominal ultrasongraphy revealed slight effusion around the liver,kidney,spleen,and in his abdominal cavity.His hemoglobin was 80 g/L 48 hours after the withdrawal of nadroparin calcium.Subsequently,he was given symptomatic and supportive treatments and the above-mentioned symptoms were alleviated gradually.Four days after drug withdrawal,the patient began to eat liquid food and gastrointestinal hemorrhage did not recur anymore.His hemoglobin was 120 g/L 4 weeks after drug withdrawal and he remained in a stable condition during 8 months of follow-up.

关 键 词：那屈肝素钙 不良反应 消化道出血 腹部血肿 

分 类 号：R972.2[医药卫生—药品]