甲泼尼龙和维库溴铵联用相关急性类固醇肌病  

Acute steroid myopathy associated with concomitant use of methylprednisolone and vecuronium

作　　者：杨强[1] 聂秀红[1] 滕国杰[1] 

机构地区：[1]首都医科大学宣武医院呼吸科,北京100053

出　　处：《药物不良反应杂志》2011年第5期314-315,共2页Adverse Drug Reactions Journal

摘　　要：1例65岁男性因肺炎合并呼吸衰竭,给予高流量吸氧,亚胺培南-西司他丁钠0.5 g、1次/8 h静脉滴注,万古霉素0.5 g、1次/8 h静脉滴注,莫西沙星0.4 g、1次/d静脉滴注,甲泼尼龙160 mg/d静脉滴注。治疗3 d病情控制不佳,行气管插管和呼吸机机械通气,因患者出现躁动应用维库溴铵4 mg静脉推注,4～6 h重复给药(16～20mg/d),同时甲泼尼龙减量至80 mg/d静脉滴注。治疗5 d患者出现睁眼困难,肌力下降,四肢腱反射减弱,肌酸激酶(CK)650 U/L,考虑为急性类固醇肌病。停用维库溴铵,改为丙泊酚,甲泼尼龙减量至40 mg/d静脉滴注。2 d后症状缓解,睁眼困难消失,四肢肌力逐渐恢复。5 d后患者CK 119 U/L,肌无力症状完全消失。A 65-year-old man received high-flow oxygen inhalation, an IV infusion of imipenem/cilastatin sodium 0.5 g every 8 hours, an IV infusion of vancomycin 0.5 g every 8 hours, an IV infusion of moxifloxacin 0.4 g once daily, and an IV infusion of methylprednisolone 160 mg/d for pulmonary infection and respiratory failure. After receiving 3-day treatment, the patient was intubated and placed on a mechanical ventilator because of poor control of his condition. In addition, he was given an intravenous vecuronium 4 mg every 4-6 hours （ 16-20 mg/d） due to agitation. Meanwhile methylprednisolone was reduced to 80 mg/d given by IV infusion. After 5 days of treatments, the patient developed difficulty keeping eye open, muscle power decrease, reduced tendon reflex, and a creatine kinase level of 650 U/L. The patient was considered to be diagnosed as having acute steroid myopathy. Vecuronium was stopped and switched to propofol. Methylprednisolone was reduced to 40 mg/d given by intravenous infusion. Two days later, his symptoms relieved, difficulty keeping eye open subsided, and muscle power gradually improved. Five days later, his creatine kinase level was 119 U/L and the symptoms of muscular weakness disappeared.

关 键 词：甲泼尼龙 维库溴铵 急性类固醇肌病 

分 类 号：R595.3[医药卫生—内科学]