盐酸左氧氟沙星注射液致过敏性休克并多器官衰竭  

Levofloxacin hydrochloride injection‑induced anaphylactic shock combined with multiple organ failure

作　　者：马洁[1] 王南[2] 刘敏[1] 宋燕青[1] Ma Jie;Wang Nan;Liu Min;Song Yanqing(Department of Pharmacy,First Hospital of Jilin University,Changchun 130021,China;Department of Hand and Foot Surgery,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院药学部,长春130021 [2]吉林大学第一医院手足外科,长春130021

出　　处：《药物不良反应杂志》2021年第10期552-554,共3页Adverse Drug Reactions Journal

摘　　要：1例56岁男性患者因左前臂外伤拟行清创术,心、肝、肾功能未见异常。术前肌内注射破伤风人免疫球蛋白250 U,无不适,80 min后开始静脉滴注盐酸左氧氟沙星注射液,滴注2 min(入量约8 ml)时患者突发呼吸困难、烦躁不安、呕吐;血压因患者躁动无法测出,血氧饱和度0.82。立即停止输注左氧氟沙星,给予心电监护、吸氧等。但患者随即意识不清,心率50次/min,血压71/45 mmHg(1 mmHg=0.133 kPa)。立即行心肺复苏,并予肾上腺素、地塞米松等。考虑左氧氟沙星引起的过敏性休克,且出现Ⅱ型呼吸衰竭,将患者转入重症医学科,予有创呼吸机辅助呼吸。实验室检查示心肌肌钙蛋白T 0.253 mg/L、肌红蛋白>3000 mg/L;天冬氨酸转氨酶1079 U/L、丙氨酸转氨酶798 U/L、γ-谷氨酰转移酶157 U/L;血肌酐157μmol/L。考虑患者出现多器官衰竭。予持续血液滤过以及保护肝脏、营养心肌等对症治疗,9 d后患者撤离呼吸机;13 d后停止血液滤过;29 d后,患者神智转清,心、肝、肾等相关实验室检查指标恢复正常。A 56‑year‑old male patient was scheduled to undergo debridement due to his left forearm trauma,and functions of his heart,liver,and kidney were normal.Before operation,human tetanus immunoglobulin 250 U was injected intramuscularly without discomfort;80 minutes later,intravenous infusion of levofloxacin hydrochloride injection was started.After 2 minutes of infusion(approximately 8 ml),the patient had sudden dyspnea,dysphoria,and vomiting.His blood pressure could not be measured due to agitation and blood oxygen saturation was 0.82.Levofloxacin was immediately stopped and electrocardiographic monitoring and oxygen inhalation were given.But the patient became unconscious,his heart rate dropped to 50 beats/min,and blood pressure was 71/45 mmHg.Immediately,cardiopulmonary resuscitation was performed,and epinephrine,dexamethasone,etc.were given.Anaphylactic shock caused by levofloxacin was considered and typeⅡrespiratory failure appeared,he was transferred to the Intensive Care Unit to assist breathing with an invasive ventilator.Laboratory tests revealed cardiac troponin T 0.253 mg/L,myoglobin>3000 mg/L;aspartate aminotransferase 1079 U/L,alanine aminotransferase 798 U/L,γ-glutamyl transpeptidase 157 U/L;serum creatinine 157μmol/L.It was considered that the patient developed multiple organ dysfunction syndrome.Continuous hemofiltration,symptomatic treatments such as liver protection,and nutrient therapy for myocardium were given.After 9 days,the patient was detached from the respirator;after 13 days,hemofiltration was stopped;after 29 days,the patient′s mind became clear and the laboratory indexes of heart,liver and kidney returned to normal.

关 键 词：左氧氟沙星 药物过敏性综合征 心脏损伤 化学和药物性肝损伤 肾损伤 

分 类 号：R969.3[医药卫生—药理学]