老年重症肺炎患者血小板减少与利奈唑胺的应用分析  

Correlation between thrombocytopenia in elderly patients with severe pneumonia and use of linezolid

作　　者：葛晓竹 田巍[1] 邓晓慧[1] 原源[1] 岳睿[1] 

机构地区：[1]北京积水潭医院干部科,北京100035

出　　处：《中华医院感染学杂志》2014年第6期1372-1374,共3页Chinese Journal of Nosocomiology

基　　金：国家重点基础研究发展规划基金项目(2006CB503807);国家自然科学基金资助项目(30425010;30571971;30630031);国家长江学者奖励计划;北京市自然科学基金资助项目(7072082;7052043)

摘　　要：目的探讨老年重症肺炎患者血小板减少与应用利奈唑胺是否相关。方法调查1例重症肺炎患者抢救过程中的治疗及临床资料,该患者在肺炎加重期与恢复期分别两次应用利奈唑胺,期间监测血小板计数,并观察其变化。结果患者第1次应用利奈唑胺抗感染时是炎症反应高峰期,期间维持呼吸机辅助呼吸,血小板计数已有下降,同时合并肾功能不全、呼吸衰竭等,应用利奈唑胺6d后血小板计数进一步下降为60×109/L,停用利奈唑胺改用替考拉宁治疗,4d后血小板仍继续下降至39×109/L,经输注血小板及随病情好转血小板恢复至正常;血小板恢复正常28d后由于感染未完全控制,第2次应用利奈唑胺,治疗11d血小板均正常。结论重症肺炎患者应用利奈唑胺与出现血小板计数下降并不是简单的因果关系,而是与全身的感染状况密切相关,此时药物的选择及是否需要停药等应综合考虑患者各方面情况,同时密切监测血小板计数以便适时停药。OBJECTIVE To explore the correlation between the thrombocytopenia in elderly patients with severe pneumonia and the use of linezolid. METHODS The clinical data of 1 case of severe pneumonia was investigated, the patient used linezolid twice respectively at the exacerbation stage and the convalescent stage, the platelet counts were monitored, and the change was observed, RESULTS When the patient received lineaolid for the first time, the inflammation was at the peak period; the breathing of the patients was assisted by using maintained ventilator, the baseline platelet counts were decreased, and the patient was complicated with renal insufficiency and respiratory failure. Six days after the use of linezolid, the platelet counts were decreased to 60×10^6/L, then teicoplanin was used to replace linezolid, four days later, the platelet counts continued to decrease to 39×10^9/L, and the platelet counts were recovered to normal through the transfusion of p!atelets; twenty eight days later, linezolid was used for the second time due to the incomplete eomrol of infections, and eleven days later, the platelet counts were recovered. CONCLUSION For the patients with severe pneumonia, the use of linezolid is not simply the cause of thrombocytopenia, but it is closely related to the systemic infection. The use of antibiotics should be considered in all aspects of the patient, meanwhile, the platelet counts should be closely monitored so as to discontinue the medication immediately.

关 键 词：老年 重症肺炎 利奈唑胺 血小板减少 

分 类 号：R978.1[医药卫生—药品]