头孢哌酮舒巴坦致血液系统不良反应的病例分析  

Case Analysis of Hematological Adverse Reactions Induced by Cefoperazone and Sulbactam

作　　者：范丽萍 徐慧钰 孔祥文 颜耀东 孙慧媛 FAN Liping;XU Huiyu;KONG Xiangwen;YAN Yaodong;SUN Huiyuan(Dept.of Pharmacy,the Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China;Dept.of Pharmacy,Beijing Jiangong Hospital,Beijing 100054,China;Internet Hospital Office,the Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]北京中医药大学第三附属医院药学部,北京100029 [2]北京市健宫医院药学部,北京100054 [3]北京中医药大学第三附属医院互联网诊疗办公室,北京100029

出　　处：《中国医院用药评价与分析》2025年第2期235-239,243,共6页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：第七批全国老中医药专家学术经验继承工作项目(No.国中医药人教函〔2022〕76号)。

摘　　要：目的:总结头孢哌酮舒巴坦致血液系统不良反应的国内外文献特点,分析其发生机制及影响因素,为临床合理用药提供参考。方法:对2023年北京中医药大学第三附属医院发生的1例以及国内外文献报道的头孢哌酮舒巴坦导致的包括血小板减少、低凝血酶原血症、凝血障碍、出血等血液系统不良反应患者的临床特点进行分析。结果:137例患者(其中136例来自文献报道)的平均年龄为(66.09±18.07)岁;以呼吸系统感染为主(102例,占74.5%),大多合并心脑血管疾病、肝肾功能不全、高血压、糖尿病等基础疾病;13.9%的患者(19例)头孢哌酮舒巴坦日剂量为≥9 g;19.7%的患者(27例)用药疗程>8 d。联合用药以抗血小板药(16例,占11.7%)、抗凝血药(12例,占8.8%)、活血类中成药(7例,占5.1%)、其他抗菌药物(24例,占17.5%)居多。出血症状以皮下瘀斑、血肿或出血(27例,占19.7%),消化道出血(43例,占31.4%)以及血尿(16例,占11.7%)为主;40.1%(55例)患者的不良反应采用维生素K治疗。应用头孢哌酮舒巴坦前后,患者活化部分凝血活酶时间、凝血酶原时间、国际标准化比值、血小板计数水平的差异均有统计学意义(P<0.05)。结论:现有的有限证据表明,头孢哌酮舒巴坦致血液系统不良反应的影响因素可能涉及头孢哌酮舒巴坦的日剂量、疗程,患者年龄、营养状况、肝肾功能以及联合应用干扰凝血的药物。用药过程中,应注意监测患者的凝血功能指标及血小板计数。OBJECTIVE:To summarize the characteristics of domestic and foreign literature on hematological adverse reactions induced by cefoperazone and sulbactam,and analyze its mechanism and influencing factors,so as to provide reference for clinical rational drug use.METHODS:Clinical characteristics of one case of cefoperazone and sulbactam induced hematological adverse reactions in the Third Affiliated Hospital of Beijing University of Chinese Medicine in 2023 and cases from literature review including thrombocytopenia,hypoprothrombinemia,coagulation disorder and hemorrhage were analyzed.RESULTS:The average age of 137 patients(including 136 patients from literature reports)was(66.09±18.07)years.Most patients were respiratory system infection(102 cases,74.5%),and most of them were complicated with cardiovascular and cerebrovascular diseases,liver and kidney injury,hypertension,diabetes and other basic diseases.The daily dose of cefoperazone and sulbactam was≥9 g in 19 patients(13.9%),19.7%of the patients(27 cases)took the drug for more than 8 d.Most of the drug combination were antiplatelet drugs(16 cases,11.7%),anticoagulants(12 cases,8.8%),traditional Chinese medicine for promoting blood circulation(7 cases,5.1%)and other antibiotics(24 cases,17.5%).The bleeding symptoms were mainly subcutaneous ecchymosis,hematoma or hemorrhage(27 cases,19.7%),gastrointestinal hemorrhage(43 cases,31.4%),and hematuria(16 cases,11.7%).And 40.1%(55 cases)of adverse drug reactions were treated with vitamin K.There were statistically significant differences in activated partial thromboplastin time,prothrombin time,international standardized ratio and platelet count level before and after the application of cefoperazone and sulbactam(P<0.05).CONCLUSIONS:Available limited evidence suggests that daily dose and treatment course of cefoperazone and sulbactam,age,nutritional status,liver and kidney function and the combination of drugs that interfere with blood clotting may be risk factors of hematological adverse reactions of cefoperazone and

关 键 词：头孢哌酮舒巴坦 血液系统不良反应 病例分析 

分 类 号：R978.1[医药卫生—药品]