抗血小板与抗凝药物联用头孢哌酮舒巴坦对老年脑梗死再出血的防控  

Prevention and management of bleeding in cerebral infarction treated with antiplatelet/anticoagulant drugs combined with cefoperazone sulbactam in elderly patients

作　　者：朱玉婷 武蕊 张婷 黄牧坤 李明杰 丁一 Zhu Yu-ting;Wu Rui;Zhang Ting;Huang Mu-kun;Li Ming-jie;Ding Yi(Department of Pharmacy,3201 Hospital,Hanzhong 723000,China;Department of Pharmacy,Xijing Hospital,Air Force Medical University,Xi’an 710032,China)

机构地区：[1]三二〇一医院药学部,汉中723000 [2]空军军医大学西京医院药剂科,西安710032

出　　处：《中国药物应用与监测》2024年第5期504-508,共5页Chinese Journal of Drug Application and Monitoring

基　　金：国家自然科学基金面上项目(82274313)。

摘　　要：目的探讨抗血小板与抗凝(anti-PLT/CGL)药物联用头孢哌酮舒巴坦(CP-SB)治疗老年脑梗死患者的出血危险因素及处置措施。方法通过分析5例老年脑梗死患者使用anti-PLT/CGL药物联合CP-SB引起不同程度出血的病例,探索老年患者联合用药引起出血的机制及应对措施。结果5例患者年龄均在75岁以上,且有2种anti-PLT/CGL药物联用史,为出血的高危人群;病例1和病例3阿司匹林肠溶片的给药方式为研碎后胃管注入,是导致消化道出血的关键因素;病例1既往有下消化道出血病史,病例2、4使用激素,病例5使用利血平为消化道出血的高危因素;病例4、5抗血小板和抗凝药物联用增加了出血的概率。5例患者均使用了CP-SB,有3例凝血功能异常,1例血小板降低,换用其他药物后,异常指标即凝血功能和血小板异常指标逐渐纠正;考虑高剂量(病例2和病例5为每次3 g,每8 h 1次)、长疗程用药(病例1用药12 d、病例3用药17 d、病例5用药14 d)加强了CP-SB对肠道菌群的抑制和对机体的凝血功能的不良影响。同时,5例患者均合并使用anti-PLT/CGL药物,病例3既往有巨幼细胞性贫血病史,均是导致出血的高危因素。结论使用anti-PLT/CGL药物的老年脑梗死患者在接受CP-SB治疗时,应关注其不良反应,特别是出血事件;建议根据老年患者的生理病理状态重新评估联合用药的利弊,必要时可采取预防性措施降低出血风险;护理方面应提高患者对早期出血的辨别能力,降低再出血的发生率。Objective To investigate the risk factors and management of bleeding in elderly patients with cerebral infarction treated with antiplatelet/anticoagulant(anti-PLT/CGL)and cefoperazone sulbactam(CP-SB).Methods Analysis was conducted for 5 cases of senile cerebral infarction treated with anti-PLT/CGL drugs combined with CP-SB to explore the mechanism of hemorrhage induced by combined medication in elderly patients and its countermeasures.Results The 5 patients were at high risk for bleeding,all of whom were over 75 years of age and had a history of two anti-PLT/CGL combinations.In case 1 and case 3,aspirin enteric-coated tablets were administered by gastric tube after crushing,which was the key factor causing gastrointestinal bleeding.The history of lower gastrointestinal bleeding in case 1,steroid use in case 2 and case 4,and reserpine use in case 5 were all high risk factors for gastrointestinal bleeding.In case 4 and case 5,the combination of antiplatelet and anticoagulant drugs increased the risk of bleeding.All of the 5 patients were treated with CP-SB.Of the 5 patients,3 had abnormal coagulation function and 1 low platelet count and the abnormal indicators refer to coagulation and markers of platelet abnormalities were gradually corrected when CP-SB was replaced.The high dose(case 2 and case 5,3 g every time,q8h)and long course(12 days in case 1,17 days in case 3,14 days in case 5)of treatment of CP-SB strengthened the inhibition of intestinal flora and deepened the harmful influence on blood coagulation.Meanwhile,the history of megaloblastic anemia in case 3 and the use of anti-PLT/CGL in all patients were high risk factors for bleeding.Conclusion The adverse reactions,especially the bleeding events,should be paid attention to when the elderly patients with cerebral infarction were treated with anti-PLT/CGL.Furthermore,the advantages and disadvantages of the combination therapy should be re-evaluated according to the physiopathological status of the elderly patients.When necessary,preventive measures can be

关 键 词：老年脑梗死 抗血小板与抗凝 头孢哌酮舒巴坦 出血 凝血功能 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R969[医药卫生—临床医学]