盐酸胺碘酮注射液致猩红热样红斑型药疹  

Scarlatiniform erythema drug eruption induced by amiodarone hydrochloride injection

作　　者：黄秀曼 朱红[2] 李欣晴[3] 童卫杭 

机构地区：[1]解放军火箭军总医院药学部,北京100088 [2]解放军第三0二医院药学部,北京100039 [3]江西省赣州市人民医院药学部,341000

出　　处：《药物不良反应杂志》2017年第3期213-215,共3页Adverse Drug Reactions Journal

摘　　要：1例65岁女性患者因乙型肝炎肝硬化、肺部感染、腹腔感染、呼吸衰竭给予乳果糖口服液、呋塞米、螺内酯、恩替卡韦、15%氯化钾注射液、多烯磷脂酰胆碱、丁二磺酸腺苷蛋氨酸、还原型谷胱甘肽、人血白蛋白、胸腺五肽、维生素K1、门冬氨酸鸟氨酸、哌拉西林钠他唑巴坦钠、替考拉宁、甲泼尼龙琥珀酸钠、兰索拉唑、复方甘草酸苷、苦黄注射液、硫酸沙丁胺醇溶液.因房颤加用盐酸胺碘酮（先予0.15 g缓慢静脉滴注,后用5%葡萄糖注射液稀释至10 mg/ml,3 ml/h持续静脉泵入）.第2天夜间,患者左侧大腿出现散在红斑.第3天皮疹范围扩大至左下肢,停用哌拉西林钠他唑巴坦钠、替考拉宁,给予盐酸异丙嗪25 mg 肌内注射、葡萄糖酸钙1 g静脉注射,皮疹范围减小.当晚,患者心率128次/min,盐酸胺碘酮泵速调为6 ml/h.第4天,皮疹遍及四肢和胸部,停用苦黄注射液,给予盐酸赛庚啶4 mg口服,2次/d.第7天,患者全身呈弥漫性红斑,停用胸腺五肽、复方甘草酸苷.第8天,患者皮疹颜色加深,伴脱屑,考虑为盐酸胺碘酮注射液引起的猩红热样红斑型药疹,停用该药,给予地塞米松10 mg、葡萄糖酸钙1 g静脉注射.停用盐酸胺碘酮第2天,患者皮疹好转.A 65-year-old female patient with hepatitis B cirrhosis, pulmonary infection, abdominal infection and respiratory failure received lactulose oral solution, furosemide, spironolactone, entecavir, potassium chloride injection, polyene phosphatidyl choline, ademetionine 1,4-butanedisulfonate, reduced glutathione, human albumin, thymopentin, vitamin K1, L-ornithine L-aspartate, piperacillin sodium tazobactam sodium, teicoplanin, methylprednisolone sodium succinate, compound glycyrrhizin, lanso-prazole, kuhuang injection（苦黄注射液） and salbutamol sulfate solution.Amiodarone hydrochloride injection 0.15 g was given to the patient by slow intravenous infusion due to atrial fibrillation, and then the drug was diluted by 5% glucose injection to 10 mg/ml by a continuous infusion pump delivering 3 ml/h.On day 2, scattered rash appeared on her left thigh.On day 3, the rash extended to the left leg, piperacillin sodium tazobactam sodium and teicoplanin were stopped.She was given intramuscular injection of promethazine hydrochloride 25 mg and intravenous injection of calcium gluconate 1 g, the rash area decreased.That night, the heart rate of the patient was up to 128 beats/min, and the injection pump speed of amiodarone hydrochloride was adjusted for 6 ml/h.The next day, the rash throughout the limbs and chest, kuhuang injection was stopped and oral cyproheptadine hydrochloride 4 mg twice daily was given.On day 7, the patient developed generalized diffuse erythema, thymopentin and compound glycyrrhizin were stopped.On day 8, the rash exacerbated accompanied by desquamation.Scarlatiniform erythema drug eruption induced by amiodarone hydrochloride was considered.Amiodarone hydrochloride was withdrawn.She was given intravenous injection of dexamethasone 10 mg and calcium gluconate 1 g.The next day, the rash subsided significantly.

关 键 词：盐酸胺碘酮 红斑型药疹 胺碘酮注射液 猩红热样 丁二磺酸腺苷蛋氨酸 甲泼尼龙琥珀酸钠 硫酸沙丁胺醇溶液 乳果糖口服液 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]