药物热的诊断思维(附二例报告)  

Diagnostic Thinking of Drug Fever:A Report of Two Cases

作　　者：赵妍[1] 康红军[1] 王彬[1] 胡新[1] 孟庆义[1] 

机构地区：[1]解放军总医院重症医学科,北京100853

出　　处：《临床误诊误治》2014年第1期64-67,共4页Clinical Misdiagnosis & Mistherapy

基　　金：解放军总医院科技创新苗圃基金(重点项目)(基金编号:11KMZ04);科技部科技基础性工作专项项目(2006FY230300)

摘　　要：目的探讨药物热的发病机制、临床特点及诊治要点,以提高临床医生对该疾病的认知,降低误诊率。方法对我院收治的2例药物热临床资料进行回顾性分析,同时复习相关文献。结果例1因腹部外伤致肠破裂入院急诊手术,术后发生严重腹腔感染,予美罗培南抗感染10 d,体温正常,按抗生素降阶梯治疗原则改用头孢哌酮舒巴坦钠,1周后体温再次升高,加强抗生素治疗无效,停用所有抗生素体温正常,证实为头孢哌酮舒巴坦钠所致药物热。例2心肺复苏后癫痫发作,使用卡马西平抗癫痫治疗过程中出现发热及皮疹,停药后发热及皮疹消失,证实为卡马西平所致药物热。结论药物热发病机制复杂,经常与感染性发热混淆,诊断困难。临床医生对不明原因发热应在早期鉴别诊断中考虑到药物热可能。早期识别有助于减少药物不良反应,降低医疗成本。Objective To explore the pathogenesis,clinical characteristics and key points of diagnosis and therapy of drug fever in order to improve the clinicians＇understanding and reduce the misdiagnosis rate.Methods Clinical data of two inpatients with drug fever in our hospital was retrospectively analyzed,and related literature was also reviewed at the same time.Results One patient was admitted for intestinal rupture caused by a abdominal trauma,but suffered from a severe postoperative abdominal cavity infection.Anti-infection therapy with Meropenem was given for 10 d,and the patient＇s body temperature returned to normal,and Meropenem was replaced by Cefoperazone/Sulbactam according to the deescalation therapeutic principle.The body temperature raised again after treatment for 1 week,and the reinforced antibiotic treatment also failed.The body temperature returned to normal after the use of all antibiotics was stopped,and the drug fever was proved to be caused by Cefoperazone/Sulbactam.Another patient had seizure disorder after cardio pulmonary resuscitation,and fever and skin rash were found during Carbamazepine antiepileptic treatment process.Drug fever and skin rash disappeared after the drug therapy was stopped,which proved that the drug fever was caused by Carbamazepine.Conclusion Pathogenesis of drug fever is complex and may easily be confused with infective fever.Clinicians should consider the possibility of drug fever in the process of diagnosis of fever of undetermined origins in prophase so as to reduce the adverse drug reaction rate and medical cost.

关 键 词：药物热 头孢哌酮 卡马西平 诊断 

分 类 号：R441[医药卫生—诊断学]