炔诺酮致急性肺栓塞并心脏停搏  

Norethindrone-induced acute pulmonary embolism with cardiac arrest

作　　者：郭文斌 王停停 刘清岳[1] 位新红 Guo Wenbin;Wang Tingting;Liu Qingyue;Wei Xinhong(Department of Intensive Care Unit,the Second People′s Hospital of Liaocheng Affiliated to Shandong First Medical University,Shandong Province,Linqing 252600,China)

机构地区：[1]山东第一医科大学附属聊城市第二人民医院重症医学科,临清252600

出　　处：《药物不良反应杂志》2024年第10期638-640,共3页Adverse Drug Reactions Journal

摘　　要：1例44岁女性患者因子宫内膜非典型增生症给予炔诺酮5 mg、1次/8 h。1个月后患者出现气喘伴紫绀,继而突发心脏停搏。根据患者心电图和超声心动图检查结果,诊断为急性肺栓塞合并心脏停搏。立即行心脏复苏,给予溶栓、抗凝治疗,行静-动脉体外膜肺氧合(VA-ECMO)维持生命。溶栓治疗5 min后患者心搏和血压逐渐恢复。行肺动脉CT造影,支持急性肺栓塞的诊断,溶栓有效。溶栓治疗31 h后患者生命体征平稳,VA-ECMO撤机;47 h后患者神志完全恢复,拔除气管插管,继续抗凝治疗。溶栓治疗11 d后复查超声心动图肺动脉压恢复正常,运动耐量检查良好。随访1个月,超声心动图心功能及结构正常,下肢血管超声未见血栓。A 44-year-old female patient was treated with norethisterone 5 mg once every 8 hours due to atypical hyperplasia of endometrium.One month later,the patient developed asthma with cyanosis,and sudden cardiac arrest later.According to the results of electrocardiogram and echocardiogram examination,acute pulmonary embolism with cardiac arrest was diagnosed.Cardiac resuscitation was immediately implemented,and thrombolysis and anticoagulation therapies were performed,accompanied by veno-arterial extracorporeal membrane oxygenation(VA-ECMO)for life support.After 5 minutes of thrombolytic therapy,the patient′s heart beat and blood pressure gradually recovered.The results of pulmonary artery CT angiography supported the diagnosis of acute pulmonary embolism and effectiveness of thrombolysis.After 31 hours of thrombolytic therapy,the patient has stabilized vital signs and VA-ECMO was removed.After 47 hours of thrombolytic therapy,the patient′s consciousness fully recovered,the tracheal tube was removed,and anticoagulant therapy was continued.After 11 days of thrombolytic therapy,the echocardiography was re-performed,showing normal pulmonary artery pressure,and the exercise tolerance was checked to be good.At 1 month of follow-up,the cardiac function and structure were normal on echocardiography,no thrombus was found on lower limb vascular ultrasound.

关 键 词：子宫内膜增生症 肺栓塞 炔诺酮 心脏停搏 体外膜肺氧合 

分 类 号：R969.3[医药卫生—药理学]