万古霉素致药物热伴血细胞减少案例分析  

Case analysis of vancomycin-induced fever with cytopenia

作　　者：邱刚[1] 刘芳琳 张芸[2] 宋美琳 李洪英 陈海莉 QIU Gang;LIU Fang-lin;ZHANG Yun;SONG Mei-lin;LI Hong-ying;CHEN Hai-li(Department of Pharmacy,Haiyan People's Hospital,Haiyan 314300,China;Department of General Surgery II,Haiyan People's Hospital,Haiyan 314300,China;Department of Pharmacy,Affiliated Hospital of Weifang Medical University,Weifang 261000,China;Department of Pharmacy,the 83th Hospital PLA,Xinxiang 453000,China)

机构地区：[1]海盐县人民医院药剂科,浙江海盐314300 [2]海盐县人民医院普外科二,浙江海盐314300 [3]潍坊医学院附属医院药剂科,山东潍坊261000 [4]中国人民解放军陆军第八十三集团军医院药剂科,河南新乡453000

出　　处：《中国药物应用与监测》2020年第3期210-212,共3页Chinese Journal of Drug Application and Monitoring

基　　金：浙江省海盐县卫健局科研项目(2017wszd006);浙江省海盐县科技局科研项目(2017Y3B2007)。

摘　　要：1例56岁女性患者因左侧腘窝囊肿行左侧腘窝囊肿切除术,术后第3日出现高热,考虑切口感染,予头孢呋辛静脉滴注抗感染,术后第6日,患者仍然出现高热,予以头孢呋辛静脉滴注联合左氧氟沙星片口服抗感染治疗,术后第9日患者仍出现高热,考虑当前抗感染方案疗效不佳,因此予以停用,改用万古霉素(1 g,q 12 h,ivgtt)抗感染治疗,1 d后患者体温恢复正常,感染逐步控制。术后第18日患者再次出现高热,术后第21日出现白细胞、中性粒细胞减少。临床药师会诊考虑为万古霉素导致发热及血细胞减少,建议停用万古霉素,停用48 h后患者体温恢复正常,停用万古霉素4 d后复查血常规,白细胞计数和中性粒细胞计数恢复正常,患者好转后出院。A 56-year-old female patient developed high fever on the third day after resection of the left popliteal cyst.Intravenous cefuroxime was given to her for postoperative infection.On the 6th after surgery,high fever was still continued and levofloxacin tablets was given to her in combination with intravenous cefuroxime.On the 9th after surgery,high fever was not obviously improved and vancomycin(1 g,q 12 h,ivgtt)was given to her after stopping cefuroxime and levofloxacin.Her body temperature returned to normal one day later and the infection was gradually controlled.On the 18th after surgery,she developed high fever again.And she further developed leukopenia and neutropenia on the 21st after surgery.Vancomycin caused fever and cytopenia was considered after consultation of clinical pharmacist and vancomysin was suggested to stop.The patient's body temperature returned to normal 48 hours later.And the count of white blood cells and neutrophils returned to normal 4 days later.The patient was discharged with the improved condition.

关 键 词：万古霉素 药品不良反应 药物热 白细胞减少 中性粒细胞减少 

分 类 号：R978.1[医药卫生—药品]