去氧孕烯炔雌醇片致颅内静脉窦血栓形成病例分析  

Analysis of the desogestrel and ethinylestradiol contraceptive tablets lead to adverse events venous thrombosis

作　　者：褚燕琦[1] 刘琛[1] 姜佳琪 裴彤[1] 王之舟[1] 闫素英[1] 

机构地区：[1]首都医科大学宣武医院药剂科,北京100053

出　　处：《药物不良反应杂志》2017年第5期335-339,共5页Adverse Drug Reactions Journal

摘　　要：目的 了解去氧孕烯炔雌醇片致颅内静脉窦血栓形成（CVST）的临床特点. 方法 收集首都医科大学宣武医院确诊4例和国内文献报道1例去氧孕烯炔雌醇片致CVST患者的临床资料进行汇总分析. 结果 5例患者年龄为19~49岁,平均（37 ± 12）岁;1例超重;用药原因分别为功能性子宫出血（3例）、月经失调（1例）和避孕（1例）,剂量为1片、1次/d（月经来潮第1天开始连续服用21 d,停7 d,再开始下一个周期用药）,其中1例发病前过量服药（8片）;发病时服药时间为27 d^5年（27、50 d和2、3、5年）;起病均有头痛（3例为剧烈全头部疼痛）,4例出现意识障碍,3例伴有恶心、呕吐,1例出现继发性癫痫.5例Naranjo评分均≥7分,即去氧孕烯炔雌醇与CVST的关联性评价结果为很可能.首都医科大学宣武医院收治的4例患者住院时间为10~40 d,经颅内静脉窦碎栓、拉栓和抗凝治疗,出院时完全康复1例,遗留肢体运动障碍1例,遗留构音障碍1例,由昏迷转为昏睡状态1例（可自主睁眼）.文献报道1例患者住院时间为30 d,经内科抗凝治疗后康复. 结论 去氧孕烯炔雌醇片所致CVST初始症状无特异性,用药后出现头痛者须警惕CVST,应进行相关检查以尽早明确诊断.及时停药并接受治疗者预后较好.Objective To explore the clinical characteristics of desogestrel and ethinylestradiol contraceptive tablets induced cerebral venous sinus thrombosis（CVST）. Methods Five cases with desogestrel and ethinylestradiol contraceptive tablets induced CVST,including 4 cases from Xuanwu Hospital of Capital Medical University and 1 case from domestic literature report,were collected and analyzed. Results The age of the 5 patients was 19-49 years old,and the average age was（37 ± 12）years. One case was overweight. Causes for using drugs were respectively functional uterine bleeding（3 cases）,menstrual disorder（1 case）and contraception（1 case）,dosage was 1 tablet once daily（take 21 d,stop 7 d,and start the next cycle）. One case had overdose before onset（8 tablets）. The duration of the drug use was 27 d to 5 years（27 d,50 d and 2,3,5 years）. The patients all developed headache（3 cases had severe head pain）,consciousness disorder（4 cases）,nausea and vomiting（3 cases）,and secondary epilepsy （1 case）. The results of 5 cases of Naranjo score≥ 7,namely,the correlation between desogestrel and ethinylestradiol tablets with CVST was highly likely. Of four patients admitted to Xuanwu Hospital of Capital Medical University length of stay for 10-40 d,after the intracranial venous sinus thrombectomy,embolectomy and anticoagulant therapy,1 case fully recovered,1 case had left limbs dyskinesia,1 case had legacy dysarthria,and 1 case shifted from coma to lethargy（the patient could open eyes autologously）. The case from domestic literature was hospitalized for 30 d,and recovered after anticoagulation treatment. Conclusions The initial symptoms of CVST were non-specific due to the use of desogestrel and ethinylestradiol contraceptive tablets. The patients who had headache after taking the drugs should be considered about CVST and should be screened for the diagnosis as soon as possible. It is better to stop the medicine in time and receive treatment for the adverse effects.

关 键 词：脱氧孕烯 炔雌醇 窦血栓形成 颅内 

分 类 号：R979.21[医药卫生—药品]