1例注射用哌拉西林-他唑巴坦钠致患者白细胞减少的原因分析及其对策
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摘要
目的:了解哌拉西林-他唑巴坦钠致患者白细胞减少的发生时间、严重程度及可行处理方法,并分析其产生的可能机制,为临床类似病历的处理提供参考。方法:对临床诊疗过程中发现的1例哌拉西林-他唑巴坦钠致白细胞减少的典型病例进行分析。结果:该例患者发生白细胞减少在使用哌拉西林他唑巴坦6 d后,出现白细胞下降,继续使用第18天时并持续口服升白细胞药物,白细胞较前仍急剧下降,经停药、对症处理3 d后白细胞恢复正常。结论:对于长期大剂量使用哌拉西林钠-他唑巴坦钠的患者,应密切关注患者临床症状并定期复查血常规,以期尽早发现不良反应的发生,及时停药或对症治疗。
Objective: To study the occurrence time, severity and feasible treatment of leukopenia induced by piperacillin sodium and tazobactam sodium for injection in clinic and to analyze its possible mechanism, so as to provide reference for the treatment of similar clinical cases. Methods: During the clinical diagnosis and treatment, a typical case of leukopenia caused by piperacilin-tazobactam sodium was analyzed. Results: After 6 days of piperacillin sodium and tazobactam sodium for injection, leukopenia was found in this case. Continuing to use for 18 days and having oral leukocyte-raising drugs, the patient's leukocytes are still sharply lower than before, after withdrawal of symptomatic treatment, the patient returned to normal after 3 days. Conclusion: For patients with long-term high-dose administration of piperacillin-tazobactam sodium, it is necessary to pay close attention to the clinical symptoms of patients and regularly conduct the blood routine, so as to detect the occurrence of adverse reactions as early as possible, and stop the drug or symptomatic treatment on time.
Objective: To study the occurrence time, severity and feasible treatment of leukopenia induced by piperacillin sodium and tazobactam sodium for injection in clinic and to analyze its possible mechanism, so as to provide reference for the treatment of similar clinical cases. Methods: During the clinical diagnosis and treatment, a typical case of leukopenia caused by piperacilin-tazobactam sodium was analyzed. Results: After 6 days of piperacillin sodium and tazobactam sodium for injection, leukopenia was found in this case. Continuing to use for 18 days and having oral leukocyte-raising drugs, the patient's leukocytes are still sharply lower than before, after withdrawal of symptomatic treatment, the patient returned to normal after 3 days. Conclusion: For patients with long-term high-dose administration of piperacillin-tazobactam sodium, it is necessary to pay close attention to the clinical symptoms of patients and regularly conduct the blood routine, so as to detect the occurrence of adverse reactions as early as possible, and stop the drug or symptomatic treatment on time.
引文
[1] Lee K WC, Kai MC, Chan NPH, et al. Piperacillin/tazobactam induced myelosuppression[J]. J Clin Med Res,2009, 1(1):53-55.
[2] Scheetz MH, Mckoy JM, Parada JP, et al. Systematic review of piperacillin-induced neutropenia.[J]. Drug Safety,2007, 30(4):295-306.
[3] Neftel KA, W?lti M, Spengler H, et al. Neutropenia after penicillins:Toxic or immune-mediated?[J]. Klinische Wochenschrift, 1981, 59(16):877-888.
[4]杨媛,张威,毛璐,等.哌拉西林钠他唑巴坦钠致白细胞减少的临床特征分析[J].中国医院药学杂志,2014,4(7):550-552.
[5]赵天,武迎磊.哌拉西林钠他唑巴坦钠致白细胞减少症的调查分析[J].临床合理用药杂志,2018,(5):88-89.
[6]何忠芳,郑茂华,武新安,等.哌拉西林钠他唑巴坦钠致白细胞减少[J].药物不良反应杂志,2012,14(5):308-309.
[7]张锋,徐琼.哌拉西林他唑巴坦联合左氧氟沙星致药物热伴白细胞减少2例[J].温州医科大学学报,2015,45(1):76-77.
[8]刘静,严郁,徐珽.注射用哌拉西林钠他唑巴坦钠致白细胞减少及高热1例[J].中国药业,2015,(13):95-95.
[2] Scheetz MH, Mckoy JM, Parada JP, et al. Systematic review of piperacillin-induced neutropenia.[J]. Drug Safety,2007, 30(4):295-306.
[3] Neftel KA, W?lti M, Spengler H, et al. Neutropenia after penicillins:Toxic or immune-mediated?[J]. Klinische Wochenschrift, 1981, 59(16):877-888.
[4]杨媛,张威,毛璐,等.哌拉西林钠他唑巴坦钠致白细胞减少的临床特征分析[J].中国医院药学杂志,2014,4(7):550-552.
[5]赵天,武迎磊.哌拉西林钠他唑巴坦钠致白细胞减少症的调查分析[J].临床合理用药杂志,2018,(5):88-89.
[6]何忠芳,郑茂华,武新安,等.哌拉西林钠他唑巴坦钠致白细胞减少[J].药物不良反应杂志,2012,14(5):308-309.
[7]张锋,徐琼.哌拉西林他唑巴坦联合左氧氟沙星致药物热伴白细胞减少2例[J].温州医科大学学报,2015,45(1):76-77.
[8]刘静,严郁,徐珽.注射用哌拉西林钠他唑巴坦钠致白细胞减少及高热1例[J].中国药业,2015,(13):95-95.