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題 名 | 疑似Cefoperazone引起出血案例=Cefoperazone Induced Severe Coagulopathy with PT/INR Prolong and Spontaneous Bleeding: A Case Report |
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作 者 | 游佳玲; 江俐慧; 陳琦華; | 書刊名 | 藥學雜誌 |
卷 期 | 32:3=128 2016.09[民105.09] |
頁 次 | 頁97-102 |
分類號 | 414.91 |
關鍵詞 | 維他命K1; Cefoperazone; N-methyl-thiotetrazol; NMTT; INR; |
語 文 | 中文(Chinese) |
中文摘要 | 一位腎功能不全接受規律血液透析的68歲結核性脊椎炎女性病人,因肺炎接 受經驗性抗生素 cefoperazone 2 g + sulbactam 2 g (Brosym) 治療,治療一周後,疑 似 cefoperazone 引起凝血酶原時間 (prothrombin, PT) 及國際標準化比值 (international normalized ratio, INR) 異常嚴重升高,進一步造成牙齦出血、血尿及腸胃道出血。改 用其他抗生素,並給予3天維他命 K1及新鮮冷凍血漿治療後,凝血指數逐漸回復且 出血現象好轉。Cefoperazone 為結構上帶有 N-methyl-thiotetrazol (NMTT) 支鏈抗生 素,會抑制肝臟中環氧化維生素K還原酶 (vitamin K epoxide reductase),引起維他命K 缺乏,造成凝血因子減少與凝血酶原時間 (PT) 及國際標準化比值 (INR) 升高。肝臟 製造凝血因子 II、VII、IX、X 時須有維他命K,缺乏維他命K將導致凝血指數異常與 出血問題。本案例以 Naranjo score 評估表評分為6分,顯示此案例「極有可能」為使 用 Brosym 引起凝血功能異常合併自發性出血。有鑒於國內目前沒有相關凝血功能異 常合併自發性出血之案例文獻報導,本文藉此案例討論具有多項危險因子之病人使用 Brosym 時,建議嚴密切監測 PT、APTT 及 INR。在感染控制的同時,以確保病人的 用藥安全。 |
英文摘要 | Here we report a 68-year old female with with TB spondylitis, pneumonia and kidney injury under hemodialysis. After 1 week of cefoperazone/sulbactam (2 g/2 g every 12 hr) therapy for pneumonia, a prothrombin time (PT) and an international normalized ratio (INR) were markedly elevated from baseline with gum bleeding, bruising, coffee ground and hematuria were noted. Brosym was discontinued. Vitamin K1 and fresh frozen plasma were administered. After 3-day therapy with fresh-frozen plasma and vitamin K1 supplement, her coagulopathy with bleeding improved gradually. Cefoperazone, which contain N-methyltiotetrazole (NMTT) side chain, were reported to cause deficiencies of clotting factors and prolonged PT by inhibiting vitamin K epoxide reductase, which led to decreased levels of the reduced form of vitamin K. Vitamin K is necessary for the synthesis of such clotting factors as prothrombin (factor II), VII, IX, and X in the liver and its deficiency causes abnormal prothrombinemia and bleeding problems. This event could be classified as probable (Narango score 6 points). We've emphasized that clinicians need to identify patients at risk for developing Brosym-associated hypoprothrombinemia, monitor them closely. |
本系統中英文摘要資訊取自各篇刊載內容。