1例儿童输注万古霉素致全血细胞减少症合并迟发型药物热的病例分析  

Analysis of a case of pancytopenia complicated with delayed drug fever induced by vancomycin infusion in a child

作　　者：陈晓旭 吴非燃 李洪盟 荆自伟 张辉[3] CHEN Xiaoxu;WU Feiran;LI Hongmeng;JING Ziwei;ZHANG Hui(Dept.of Pharmacy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Dept.of Minimal Invasive Spinal Surgery,Luoyang Orthopedic-Traumatological Hospital of Henan Province,Zhengzhou 450016,China;Dept.of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院药学部,郑州450052 [2]河南省洛阳正骨医院脊柱微创外科,郑州450016 [3]郑州大学第一附属医院小儿外科,郑州450052

出　　处：《中国药房》2023年第17期2139-2143,共5页China Pharmacy

基　　金：国家自然科学基金项目(No.82003956);河南省医学科技攻关计划(联合共建)项目(No.LHGJ20190277)。

摘　　要：目的 准确识别万古霉素较罕见的药品不良反应(ADR)——全血细胞减少症,以促进该药的安全使用。方法 通过1例化脓性髋关节炎患儿静脉输注万古霉素后发生全血细胞减少症合并迟发型药物热的病例报告,采用Naranjo评分结合文献资料,评估该ADR与治疗药物的关系及其可能的发生机制,提出儿童患者合理使用万古霉素的建议。结果与结论 该患儿发生的全血细胞减少症合并迟发型药物热与万古霉素的关联性为“很可能”。临床上全血细胞减少症合并迟发型药物热与感染加重导致的发热、血细胞减少较难区分,医护人员应提高对全血细胞减少症等万古霉素较罕见ADR的警觉性,药师应协助医护人员及时甄别ADR。儿童输注万古霉素初始剂量宜从60 mg/(kg·d)开始,且应在首次用药后48 h进行血药浓度监测并及时调整剂量,使万古霉素谷浓度维持在5~15 mg/L,以防止因血药浓度过高导致ADR的发生;对于万古霉素使用超过1周的患儿,应定期复查血常规,一旦发生全血细胞减少应立即停药,并根据情况给予对症治疗。OBJECTIVE To accurately identify the rare adverse drug reactions(ADR) of vancomycin-pancytopenia in order to promote its safe use.METHODS Through a case report of a child with suppurative hip arthritis who developed pancytopenia combined with delayed drug fever caused by intravenous infusion of vancomycin,Naranjo score method and related literature were used to summarize the association between the ADR and vancomycin and its possible mechanism,and suggestions for rational use of vancomycin in pediatric patients were put forward.RESULTS CONCLUSIONS The association of pancytopenia combined with delayed drug fever and vancomycin in this child is “very likely”.In clinical practice,it is difficult to distinguish between pancytopenia combined with delayed drug fever from fever and hematopenia caused by aggravation of infection.Medical staff should increase their awareness of vancomycin rare ADR such as pancytopenia,and pharmacists should assist medical staff in timely screening for ADR.The initial dose of vancomycin infusion for children should start from 60 mg/(kg·d),and the blood concentration should be monitored 48 h after the first infusion and the dose should be adjusted in time to maintain the valley concentration of vancomycin at 5-15 mg/L to prevent the occurrence of ADR caused by excessive blood concentration.For children who have been using vancomycin for more than one week,the blood routine should be rechecked regularly.Once pancytopenia occurs,the drug should be stopped immediately,and symptomatic treatment should be given according to the situation.

关 键 词：万古霉素 儿童 全血细胞减少症 迟发型药物热 病例分析 

分 类 号：R969.3[医药卫生—药理学] R978.1[医药卫生—药学]