心血管外科术后万古霉素治疗致红人综合征的诊疗经验  

Experience in diagnosis and treatment of red man syndrome caused by vancomycin after cardiovascular surgery

作　　者：杨蓉 高雅萱 李坤生 王东进[1] 徐航 曹海龙 YANG Rong;GAO Yaxuan;LI Kunsheng;WANG Dongjin;XU Hang;CAO Hailong(Department of Cardio-Thoracic Surgery,Nanjing Drum Tower Hospital,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Jiangsu Nanjing 210008,China;Department of Pharmacy,Nanjing Drum Tower Hospital,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Jiangsu Nanjing 210008,China)

机构地区：[1]南京中医药大学鼓楼临床医学院,南京鼓楼医院心胸外科,江苏南京210008 [2]南京中医药大学鼓楼临床医学院,南京鼓楼医院药学部,江苏南京210008

出　　处：《中国医院药学杂志》2024年第3期323-326,共4页Chinese Journal of Hospital Pharmacy

基　　金：南京市卫生科技发展专项资金项目(编号:ZKX20026)。

摘　　要：目的:分析心血管外科术后万古霉素抗感染治疗导致红人综合征临床症状及演变过程,为临床治疗提供诊疗依据。方法:回顾性分析2016年3月至2022年8月期间在南京鼓楼医院心胸外科因心血管外科术后使用万古霉素抗感染治疗导致红人综合征的18例患者,分析病种、发病症状及演变过程、万古霉素剂量和血药浓度,并记录所有患者救治方式、临床转归等资料。结果:18例患者中17例是感染性心内膜炎和主动脉夹层患者,红人综合征发病和万古霉素浓度过高及国产万古霉素使用有关,早期2例因消化道和气道黏膜水肿出血导致死亡,其余均经治疗治愈出院。结论:红人综合征是心血管外科术后万古霉素抗感染的常见并发症,应注意选择较纯的制剂并监测血药浓度。早期出现斑丘疹应立即停药并给予激素干预,防止出现血管神经性水肿导致的呼吸道梗阻和消化道出血,以致不良预后。OBJECTIVE To analyze the clinical symptoms and evolution process of red man syndrome(RMS)caused by vancomycin after cardiovascular surgery,and provide diagnostic and therapeutic basis for clinical treatment.METHODS Retro⁃spective analysis was made on 18 patients with RMS treated with vancomycin for anti-infection after cardiovascular surgery in Car⁃diothoracic Surgery Department of Nanjing Drum Tower Hospital from March 2016 to August 2022.The disease type,symptoms and evolution,vancomycin dose and blood concentration were analyzed,and the treatment methods and clinical outcomes of all the patients were recorded.RESULTS Among the 18 patients,17 were with infective endocarditis and aortic dissection.The inci⁃dence of RMS was related to the high concentration of vancomycin and the use of domestic vancomycin.In the early stage,two patients died due to edema and bleeding of digestive tract and airway mucosa,and the rest were cured and discharged after treat⁃ment.CONCLUSION RMS is a common complication of vancomycin anti-infection after cardiovascular surgery.We should pay attention to the selection of pure preparations and monitoring of blood drug concentration.Early occurrence of maculopapules requires drug withdrawal and hormone intervention to prevent dragging to angioneurotic edema,leading to respiratory obstruction and gastrointestinal bleeding,resulting in poor prognosis.

关 键 词：万古霉素 红人综合征 心血管外科手术 诊疗经验 

分 类 号：R978.16[医药卫生—药品]