急性视神经炎药物治疗的安全性分析  

Safety Analysis of Drug Therapy for Acute Optic Neuritis

作　　者：刘永娇 宋智慧[1] 张弨 Liu Yongjiao;Song Zhihui;Zhang Chao(Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院

出　　处：《中国药事》2019年第11期1320-1324,共5页Chinese Pharmaceutical Affairs

摘　　要：目的:对大剂量甲泼尼龙琥珀酸钠治疗急性视神经炎的安全性进行研究分析方法:选取首都医科大学附属北京同仁医院2018年1月-8月急性视神经炎患者药物治疗后出现不良反应者共80例作为研究分析对象,对所用患者临床资料进行分析,对出现不良反应的特点进行总结。结果:205例急性视神经炎患者中有80例发生不良反应,均考虑与大剂量糖皮质激素的使用有关。其中男28例,女52例;平均年龄45.34±16.64岁。有变态反应史的患者17例,无变态反应史者55例,变态反应史记录不详者8例。从发生时间上看,用药当天出现的13例(6.34%),连续用药2~6天后发生的42例(20.49%),连续用药>6天发生的25例(12.20%);按照不良反应的发生率统计,白细胞升高比例最高(38,18.54%),其次是血糖升高(35,17.07%),然后是肝功能异常(32,15.61%),失眠(16,7.80%),皮疹(7,3.41%),血压升高(6,2.93%),其他(13,6.34%);从严重程度上评估,严重不良反应17例(8.29%),主要涉及肝功能损害(9例,4.39%)、血糖升高(5例,2.44%)、低钾血症(2例,0.98%)、消化道出血(1例,0.49%)。结论:糖皮质激素导致的不良反应多发生在用药第2~6天,提示该时间段是重点关注各类不良反应发生的关键时间;同时,严重肝功能损害延长住院时间、血糖升高导致糖尿病高渗性昏迷、消化道出血导致住院时间延长等情况也并不少见,希望临床能够高度警惕。Objective:To analyze the safety of high dose methylprednisolone sodium succinate in the treatment of acute optic neuritis.Methods:A total of 80 cases of patients with adverse reactions after drug treatment of acute optic neuritis in our hospital from January to August 2018 were selected as subjects for research and analysis.The clinical data of the patients were analyzed and the characteristics of the adverse reactions were summarized.Results:The adverse reactions occurred in 80 of the 205 patients with acute optic neuritis,all of which were considered to be relating to the use of high dose of glucocorticoids.Among them,28 were male and52 were female.The average age was 45.34±16.64 years.There were 17 patients with history of allergic reaction,55 patients with no history of allergic reaction and 8 patients with unknown history of allergic reaction.In terms of occurrence time,13 cases(6.34%) occurred on the day of medication,42 cases(20.49%) occurred after 2 to 6 days of continuous medication,and 25 cases(12.20%) occurred after more than 6 days of continuous medication.According to the statistics of the incidence of adverse reactions,the proportion of increased white blood cells was the highest(38,18.54%),followed by increased blood glucose(35,17.07%),abnormal liver function(32,15.61%),insomnia(16,7.80%),skin rash(7,3.41%),increased blood pressure(6,2.93%),and others(13,6.34%).In terms of severity,there were 17 cases(8.2%) of severe adverse reactions,mainly involving liver function damage(9,4.39%),elevated blood glucose(5,2.44%),hypokalemia(2,0.98%),and gastrointestinal bleeding(1,0.49%).Conclusion:The adverse reactions caused by glucocorticoids mainly occurred after 2 to 6 days of medication,suggesting that this time period is the critical period for all kinds of adverse reactions.Meanwhile,the hospitalization time is extended due to severe liver function damage and gastrointestinal bleeding,diabetes hypertonic coma is caused by elevated blood sugar and so on,which must be on high alert clinically.

关 键 词：视神经炎 甲泼尼龙 不良反应 

分 类 号：R9[医药卫生—药学]