头孢哌酮舒巴坦致肾功能不全患者维生素K缺乏性严重凝血障碍  

Serious Vitamin K⁃Deficient Coagulation Disorder Induced by Cefoperazone/Sulbactam in Patients with Renal Insufficiency

作　　者：杜雨末 颛孙永勋 高思远 潘增凯 聂大年 李益清 谢双锋 黄克智 DU Yu-mo;ZHUAN SUN Yong-xun;GAO Si-yuan;PAN Zeng-kai;NIE Da-nian;LI Yi-qing;XIE Shuang-feng;HUANG Ke-zhi(Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation,510120;Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University;National Research Center for Translational Medicine,Ruijin Hospital Affiliated to Shanghai Jiao Tong University(SJTU)School of Medicine,Shanghai)

机构地区：[1]广东省恶性肿瘤表观遗传与基因调控重点实验室,510120 [2]中山大学孙逸仙纪念医院 [3]上海交通大学医学院附属瑞金医院国家转化医学中心

出　　处：《岭南急诊医学杂志》2021年第6期610-613,共4页Lingnan Journal of Emergency Medicine

摘　　要：目的:分析头孢哌酮舒巴坦诱发凝血障碍的高危因素及应对策略。方法:分析总结使用头孢哌酮舒巴坦后出现维生素K缺乏性严重凝血障碍的病例特点。结果:52例中有4例(7.7%)发生了显著凝血障碍。4例患者的中位年龄为68岁,基线肾功能不全,使用头孢哌酮舒巴坦至出现凝血异常或出血的中位时间为10.5 d,出血表现包括皮下出血、消化道出血、血尿、可疑颅内出血等。Naranjo药物不良反应评分中位得分4.5分。高龄、肾功能不全、低白蛋白血症、合并用药复杂、进食不足是高危因素。维生素K依赖的凝血因子活性显著低下,及时补充维生素K1及凝血因子有效纠正凝血异常。结论:头孢哌酮舒巴坦可诱发肾功能不全患者维生素K缺乏性严重凝血障碍并导致致命性出血。临床使用应个体化,加强对出血症状、凝血功能及头孢哌酮血药浓度的监测,必要时补充维生素K1及凝血因子。Objective:To analyze the risk factors and management of abnormality of coagulation induced by cefoperazone/sulbactam.Methods:Four cases of severe Vitamin K⁃Deficient coagulation disorder after cefoperazone/sulbactamin exposure were retrospectively studied.Results:Of 52 cases,4 cases(7.7%)developed serious coagulation disorder.All had impaired renal function before the exposure to cefoperazone/sulbactamin,with a median age of 68 years.The median time from initiation of cefoperazone/sulbactam to coagulation disorder was 10.5 days.Bleeding manifestations varied from no obvious bleeding to subcutaneous,gastrointestinal bleeding,hematuria and suspicious fatal intracranial hemorrhage,with a median Naranjo adverse drug reaction probability score of 4.5.High risk factors for abnormality of coagulation included elderly,renal insufficiency,hypoalbuminemia,complexity of combined medications and poor food intake.Remarkable low activity of vitamin K⁃dependent coagulation factors were detected.Supplement of vitamin K1 and coagulation factors timely was an effective measure for the recovery.Conclusion:Cefoperazone/sulbactam is prone to induce serious vitamin K⁃deficient coagulation disorder and potentially fatal bleeding among the patients with renal insufficiency.Personalization of medication,monitoring of coagulation and concentration of cefoperazone,and timely supportive care including supplement of vitamin K1 and coagulation factors is clearly warranted.

关 键 词：头孢哌酮舒巴坦 凝血障碍 维生素K缺乏 肾功能不全 药物不良反应 

分 类 号：R969.3[医药卫生—药理学]