哌拉西林他唑巴坦诱发溶血性贫血的文献病例分析  

Analysis of literature case reports on hemolytic anemia induced by piperacillin-tazobactam

作　　者：许志连[1] 郑颖[1] 何飞燕 XU Zhilian;ZHENG Ying;HE Feiyan(Department of Pharmacy,Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310007,China)

机构地区：[1]浙江中医药大学附属杭州市中医院药剂科,杭州310007

出　　处：《药物流行病学杂志》2024年第6期688-696,共9页Chinese Journal of Pharmacoepidemiology

基　　金：杭州市医学重点学科项目—临床药学(杭卫发[2021]21号)。

摘　　要：目的分析哌拉西林他唑巴坦诱发溶血性贫血的发生情况和特点,为临床安全用药提供参考。方法计算机检索PubMed、Web of Science、CNKI、WanFang Data和VIP数据库,搜集有关哌拉西林他唑巴坦诱发溶血性贫血的病例报道,检索时限均从建库至2023年12月,并对患者的基本信息、药物的使用情况、溶血性贫血及其并发症和转归等进行统计分析。结果共纳入25篇文献27个病例,其中男14例(51.85%),女13例(48.15%),年龄4 d~77岁,首次发生溶血性贫血的时间<24h~18d不等。25例明确了发生溶血性贫血时的最低血红蛋白水平,介于27~113 g·L^(-1),其中14例为重度、极重度贫血(<60 g·L^(-1))。经停药、更换抗菌药物和对症支持治疗后,25例(92.59%)患者的溶血性贫血改善或恢复,其中1例停用哌拉西林他唑巴坦后贫血有所改善,但停药后15 d患者因多器官衰竭死亡;另外2例贫血未见好转,最终自动出院或临床死亡。结论溶血性贫血是哌拉西林他唑巴坦罕见的不良反应,症状无明显特异性,临床使用应监测血红蛋白水平,发现异常且若明确哌拉西林他唑巴坦为可疑药物应及时停药,必要时需采取输注红细胞等措施。Objective To discuss the occurrence and characteristics of hemolytic anemia induced by piperacillin-tazobactam to provide a reference for clinically safe drug use.Methods PubMed,Web of Science,CNKI,WanFang Data,and VIP were electronically searched to collect case reports of hemolytic anemia induced by piperacillin-tazobactam from inception to December 2023,and statistical analysis was conducted on patients'basic information,drug use,hemolytic anemia,complications and outcomes.Results A total of 27 patients were included in 25 literature,including 14 males(51.85%)and 13 females(48.15%),aged from 4 days to 77 years old,and the time of first occurrence of hemolytic anemia ranged from 24 h to 18 days.The minimum hemoglobin level of hemolytic anemia was determined in 25 cases,ranging from 27 to 113 g·L^(-1),of which 14 cases were severe or extremely severe anemia(<60 g·L^(-1)).After drug withdrawal,antibiotic change,and symptomatic supportive treatment,the hemolytic anemia of 25 patients(92.59%)was improved or recovered.Among them,the anemia of 1 patient was improved after stopping piperacillin-tazobactam,but the patient died of multiple organ failure 15 days after drug withdrawal.The other two patients of anemia did not improve,and eventually discharged themselves or died clinically.Conclusion Hemolytic anemia is a rare adverse reaction of piperacillin-tazobactam,and the clinical symptoms have no obvious specificity.Hemoglobin levels should be monitored in clinical use,and once the abnormality is found,if it is clear that piperacillin-tazobactam is the suspicious drug,it should be promptly discontinued,and measures such as red blood cell transfusion should be taken if necessary.

关 键 词：哌拉西林他唑巴坦 溶血性贫血 药品不良反应 病例报告 血红蛋白水平 

分 类 号：R969[医药卫生—药理学]