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舒巴坦制剂致Kounis综合征的文献病例分析

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目的 探讨含舒巴坦成分的抗菌药物致Kounis综合征(Kounis syndrome,KS)的发生情况和特点,为临床安全使用该类药物提供参考.方法 检索建库至2023年10月收录在PubMed、Embase、Cochrane Library、中国知网、万方和维普期刊数据库有关含有舒巴坦成分的抗菌药物致KS的病例报道,并对相关数据进行统计和分析.结果 共检索到11篇文献合计11例患者,男性7例(63.6%),女性4例(36.4%),年龄44~89(70.0±13.1)岁,≥70岁的有9例(81.8%).涉及药物包括头孢哌酮舒巴坦5例(45.5%)、氨苄西林舒巴坦4例(36.4%)和哌拉西林舒巴坦2例(18.2%).81.8%的患者在用药后30 min内出现急性过敏反应且心电图提示ST段异常改变.KS分型Ⅰ型、Ⅱ型和Ⅲ型分别为8例(72.7%)、2例(18.2%)和1例(9.1%).经抗过敏和抗心肌缺血等治疗后10例(90.9%)患者转归良好,1例(9.1%)最终死于心源性休克.结论 多种含有舒巴坦成分的抗菌药物可诱发KS,且以老年患者居多,多在30 min内发生.临床在使用该类制剂过程中一旦出现急性过敏反应并伴有心电图异常改变时应高度怀疑可能为其诱发的KS,及时停药并根据KS分型进行针对性治疗是改善患者预后的关键.
Literature Case Analysis of Kounis Syndrome Induced by Sulbactam and Its Compound Preparations
OBJECTIVE To discuss the occurrence and clinical characteristics of Kounis syndrome(KS)induced by antibacterial drugs containing sulbactam in order to provide references for clinical safety drug use.METHODS The case reports of KS induced by antibacterial drugs containing sulbactam were retrieved from PubMed,Embase,Cochrane Library,CNKI,Wanfang and VIP database from establishment of each database to October 2023.The relevant data were collected and analyzed.RESULTS A total of 11 cases from 11 articles were identified and included in the analysis.There were 7 males(63.6%)and 4 females(36.4%).The patients were aged from 44 to 89 years with an average age of(70.0±13.1)years old,and there were 9 patients aged 70 and above(81.8%).The drugs involved included cefoperazone sulbactam in 5 cases(45.5%),ampicillin sulbactam in 4 cases(36.4%)and piperacillin sulbac-tam in 2 cases(18.2%).The 81.8%of the patients developed acute anaphylaxis within 30 min after treatment and electrocardiogram indicated abnormal ST segment changes.Type Ⅰ,Ⅱ and Ⅲ KS were 8 cases(72.7%),2 cases(18.2%)and 1 case(9.1%),respec-tively.After anti-allergic and anti-myocardial ischemia therapy,10 patients(90.9%)had good prognosis,and 1 patient(9.1%)died of cardiogenic shock.CONCLUSION KS could be induced by a variety of antibacterial drugs containing sulbactam,especially in older patients and mostly within 30 min.KS should be highly suspected once acute anaphylaxis accompanied by abnormal changes in electrocardio-gram Timely withdrawal of medication and targeted treatment according to KS types are the key to improve the prognosis of patients.

sulbactamKounis syndromeacute coronary syndromeliterature case analysis

潘振峰、李岩、周增慧、朱建国、谢诚

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苏州大学附属第一医院药学部,江苏苏州 215000

苏州市独墅湖医院药学部,江苏苏州 215000

舒巴坦 Kounis综合征 急性冠脉综合征 文献病例分析

国家临床重点专科(临床药学)建设项目(国家卫生健康委员会办公厅)

国卫办医函[2018]292号

2024

中国药学杂志
中国药学会

中国药学杂志

CSTPCD北大核心
影响因子:0.957
ISSN:1001-2494
年,卷(期):2024.59(12)
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