盐酸丙帕他莫与头孢呋辛钠和低分子量肝素钙联用引起急性肝衰竭致死亡  

Death from acute liver failure due to concomitant use of propacetamol hydrochloride,cefuroxime sodium,and low molecular weight heparin calcium

作　　者：李宪超 李静[1] 任吉霞[1] 鹿艳 韩茂之 李圣惠 李莎莎[1] Li Xianchao;Li Jing;Ren Jixia;Lu Yan;Han Maozhi;Li Shenghui;Li Shasha(Department of Pharmacy,the 891h Hospital of PLA,Shandong Prorince,Weifang 261000,China)

机构地区：[1]中国人民解放军第八十九医院药剂科,山东省潍坊市261000

出　　处：《药物不良反应杂志》2020年第2期113-115,共3页Adverse Drug Reactions Journal

摘　　要：1例62岁男性患者因车祸致第3腰椎爆裂性骨折和多发腰椎横突骨折,给予注射用盐酸丙帕他莫镇痛,头孢呋辛钠预防感染,腺苷钴胺营养神经,低分子量肝素钙抗凝。用药前患者肝功能正常。2 d后在全麻下行腰椎后路骨折切开复位减压植骨内固定术,术前停用低分子量肝素钙。术后第3天(用药第5天)患者诉腹部胀痛,实验室检查示血清丙氨酸转移酶(ALT)9 315 U/L,天冬氨酸转氨酶(AST)10 760 U/L,γ-谷氨酰转氨酶(γ-GT)47 U/L,碱性磷酸酶(ALP)101 U/L,总胆红素(TBil)71.3 μmol/L,直接胆红素(DBil)48.5 μmol/L,间接胆红素(IBil)22.8 μmol/L,考虑为药物引起的肝损伤。停用盐酸丙帕他莫并给予保肝治疗。次日患者出现巩膜及全身皮肤黄染,继而发生神志不清、低血氧饱和度、低血压、低血糖,ALT 5 975 U/L,AST 3 659 U/L,γ-GT 100 U/L,ALP 141 U/L,TBil 175.2 μmol/L,DBil 101.4 μmol/L,IBil 73.8 μmol/L,凝血酶原时间21.2 s,诊断为急性肝衰竭。停用注射用头孢呋辛钠和腺苷钴胺,给予升压、扩容、纠正酸中毒等对症支持治疗后未见明显好转,当日转至外院。转院第4天患者因多器官功能衰竭死亡。A 62-year-old male patient received propacetamol hydrochloride for analgesia,cefuro-xime sodium for anti-infection,adenosine cobalamin for nutrition of nerve,and low molecular weight heparin caleium for anticoagulation for burst fracture of the third lumbar vertebra and multiple fractures of transverse process of lumbar spine caused by taffie accident.The patient's liver function was normal before medica-tion.He underwent the operation under general anesthesia 2 days later.Low molecular weight heparin cal-cium was stopped before the operation.On day 3 after the operation(on day 5 of medication),the patient developed abdominal distension and pain.The results of laboratory tests showed alanine aminotransferase(ALT)9315 U/L,aspartate aminotransferase(AST)10760 U/L,gamma glutamyltransferase(γ-GT)47 U/L,alkaline phosphatase(ALP)101 U/L,total bilirubin(TBil)71.3μmol/L,direct bilirubin(DBil)48.5 umol/L,and indirect bilinbin(IBi)22.8 pmol/L Drug induced liver injury was considered.Propacetamol hydrochlo-ride was discontinued and liver-protective drugs were given.The next day,the patient developed yellow staining of his sclera and whole body skin,then followed by confusion,decreased blood oxygen saturation,low blood pressure,and hypoglycemia.The results of reexamination showed ALT 5975 U/L,AST 3659 U/L,γ-GT 100U/L,ALP 141 U/L,TBil 175.2μmol/L,DBil 101.4μmol/L,IBil 73.8μmol/L,and prothrombin time 21.2 s.The patient was diagnosed as acute liver failure.Cefuroxime sodium and adenosine cobalamin were discontinued and symptomatic and supportive treatments such as inereasing blood pressure,fluid sup-plement,and correction of acidosis were given.However,the patient s condition was not improved.He was transferred to other hospital on the same day.On the 4th day,he died of muliple organ failure.

关 键 词：非那西丁 头孢呋辛 肝素 低分子量 化学和药物性肝损伤 肝衰竭 急性 

分 类 号：R575[医药卫生—消化系统]