1例青少年小舞蹈病患者合并青霉素过敏的病例分析  

Analysis of a juvenile sydenham chorea patient combined with penicillin allergy

作　　者：廖音娟[1,2] 左美玲 古春萍[3] 陈溪[4] 贾素洁[2] LIAO Yin-juan;ZUO Mei-ling;GU Chun-ping;Chen Xi;JIA Su-jie(Department of Pharmacy, the Fourth Hospital of Changsha, Changsha 410006;Department of Pharmacy, the Third Xiangya Hospital, Central South University, Changsha 410013;Department of Pharmacy, the Nanfang Hospital of Southern Medical University, Guangzhou 510515;Department of Pharmacy, Changsha Central Hospital, Changsha 410004)

机构地区：[1]长沙市第四医院药剂科,长沙410006 [2]中南大学湘雅三医院药学部,长沙410013 [3]南方医科大学南方医院药学部,广州510515 [4]长沙市中心医院药学部,长沙410004

出　　处：《中南药学》2018年第6期856-860,共5页Central South Pharmacy

摘　　要：目的以1例罕见的青少年小舞蹈病患者合并青霉素过敏的病例为出发点,探讨风湿性小舞蹈病的对症治疗、风湿热的急性期治疗以及长期的二级预防策略。方法以相关文献、专家共识和指南为依据,结合本病例的实际诊疗过程,对合并青霉素过敏的青少年小舞蹈病患者的选药问题进行了详细阐述。结果患者住院期间其舞蹈样症状得到了较好控制,选用克林霉素进行风湿热的急性期治疗,患者出院时其抗链球菌溶血素"O"测值仍高于异常,但家属仍强行出院。结论风湿性小舞蹈病患者目前在我国比较少见,该病为一种自限性疾病,其急性期的治疗并不困难,其最大的难点在于预防风湿热的复发,相应权威指南推荐为了最大限度地防止风湿热复发及避免心肌炎、心瓣膜病的发生,应使用苄星青霉素(120万U,每4周1次,肌内注射)积极进行风湿热的长期二级预防,而本例患者对青霉素过敏,需改用红霉素(0.25 g每日4次,口服)进行替代治疗,其疗程至少为10年。而对于12岁未成年的男童来说,其长达10年的红霉素累积治疗是否会给其带来严重的不良反应,其依从性和预后如何,是本文遗留的困惑点。Objective To discuss the symptomatic treatment of rheumatic chorea, acute treatment and longterm secondary prevention strategy of rheumatic fever based on a rare case of juvenile chorea with penicillin allergy. Methods The medication plan of the juvenile sydenham chorea patient with penicillin allergy was elaborated based on the relevant literature, expert consensus and guidelines, combined with the actual diagnosis and treatment process. Results Clindamycin was used for acute phase treatment of rheumatic fever due to the patient＇s allergy to many antibiotics, and the choreography symptoms were well controlled during the hospitalization. Conclusion Patients with rheumatic chorea minor are relatively rare at present in China, which is self-limited and the treatment of the acute phase is not difficult. The difficulty lies in the prevention of recurrence of rheumatic fever. Benzathine penicillin （intramuscular injection with 1 million 200 thousand U every 4 weeks） is suggested positively for the long-term secondary prevention of rheumatic fever to avoid myocarditis and cardiac valvular disease according to authority recommendations. The patient mentioned in the paper is allergic to penicillin, which is replaced by erythromycin （with 0.25 g orally 4 times daily） for at least 10 years. For a 12 year old boy, what adverse reactions the cumulative treatment of erythromycin for 10 years will bring, its compliance and prognosis remains unclear.

关 键 词：风湿热 小舞蹈病 病例分析 过敏 

分 类 号：R742.2[医药卫生—神经病学与精神病学]