头孢甲肟致肾衰竭合并胰腺炎患者凝血功能障碍  

Blood coagulation disorders caused by cefmenoxime in a patient with renal failure and pancreatitis

作　　者：杨春生 孟玉玫 姜文勇 王洪娜 梁金山 刘艳梅 阚春娜 朱学良 刘玉 遇建鹏 Yang Chunsheng;Meng Yumei;Jiang Wenyong;Wang Hongna;Liang Jinshan;Liu Yanmei;Kan Chunna;Zhu Xueliang;Liu Yu;Yu Jianpeng(Department of Clinical Laboratory,Luannan Hospital,Hebei Province,Luannan 063500,China;Department of Clinical Laboratory,Luannan Hospital,Hebei Province,Luannan 063500,China Department of Clinical Laboratory,Luannan Hospital,Hebei Province,Luannan 063500,China)

机构地区：[1]河北省滦南县医院检验科,滦南063500 [2]河北省滦南县医院内科,滦南063500

出　　处：《药物不良反应杂志》2021年第5期279-280,共2页Adverse Drug Reactions Journal

摘　　要：1例65岁女性慢性肾衰竭持续血液透析患者因患急性胰腺炎接受头孢甲肟1 g静脉滴注、2次/d。治疗前凝血酶原时间(PT)、国际标准化比值(INR)和部分凝血活酶时间(APTT)均正常。治疗11 d后,患者皮肤出现多处瘀斑,静脉穿刺处出血不易止,复查凝血功能,PT 127 s,INR 10.72,APTT 86 s。考虑患者出现凝血功能异常,给予同型去白细胞冰冻血浆150 ml静脉输注。次日复查,PT 101 s,INR 8.49,APTT 65 s;凝血纠正试验示PT、APTT均可纠正,提示凝血因子缺乏。考虑为头孢甲肟所致凝血障碍,停用该药,换用阿莫西林克拉维酸钾,同时给予维生素K_(1)10 mg皮下注射、1次/d。停药3 d后,凝血功能恢复正常(PT 15 s,INR 1.19,APTT 36 s)。A 65-year-old female patient with chronic renal failure undergoing continuous hemodialysis received an IV infusion of cefmenoxime 1 g twice daily for acute pancreatitis.The values of prothrombin time(PT),international normalized ratio(INR),and activated partial thromboplastin time(APTT)were within the normal range before treatment.After 11 days of treatment,the patient developed multiple ecchymoses on the skin and bleeding from the venipuncture site which was not easily stopped.The reexamination of coagulation function showed PT 127 s,INR 10.72,and APTT 86 s.Coagulation dysfunction was considered and an IV infusion of leukocyte-reduced fresh-frozen plasma 150 ml was given.Examination of coagulation function next day showed PT 101 s,INR 8.49,and APTT 65 s.Mixing study for evaluation of abnormal coagulation testing showed that PT and APTT could be corrected,suggesting coagulation factor deficiency.Blood coagulation disorders caused by cefmenoxime was considered.Then the drug was discontinued and switched to amoxicillin sodium and clavulanate potassium,and a subcutaneous injection of vitamin K_(1)10 mg was given once daily.Three days after the drug withdrawal,her coagulation function returned to within the normal range(PT 15 s,INR 1.19,APTT 36 s).

关 键 词：头孢甲肟 慢性肾衰竭 胰腺炎 血液凝固障碍 维生素K缺乏 

分 类 号：R969.3[医药卫生—药理学]