摘要
1例85岁男性升结肠癌患者于全麻下行腹腔镜辅助下右半结肠根治性切除术后术后第20天出现泛耐药鲍曼不动杆菌引起的肺部感染,予多黏菌素B 50万Uqid联合替加环素50mgq12h抗感染治疗.多黏菌素B用药后,患者血清肌酸磷酸激酶(creatine kinase,CK)进行性升高,用药后最高升至5 804 U·L-1,考虑为多黏菌素B所致横纹肌溶解(rhabdomyolysis,RM).另外,用药7 d后测多黏菌素B稳态血药浓度为2.1 mg·L-1.停用多黏菌素B后,血清肌酸磷酸激酶呈下降趋势并恢复至正常水平.该不良反应无剂量依赖性,为新的罕见的B类不良反应,对罕见不良反应的认识有助于确保多黏菌素B治疗的临床安全性.
Abstract
An 85-year-old male of ascending colonic can-cer developed pulmonary infection caused by Pan drug resis-tant Acinetobacter baumannii on the 20th day after laparo-scopic assisted radical resection of right colon under general anesthesia.Polymyxin B 500 000 U qid was prescribed along with tigecycline 50 mg q12h for anti-infection.After dosing of polymyxin B,serum level of creatine kinase(CK)spiked pro-gressively and peaked at 5 804 U·L-1.It was probably rhab-domyolysis(RM)caused by polymyxin B.After 7-day treat-ment,a steady-state plasma concentration of polymyxin B was attained at 2.1 mg·L-1.After a discontinuation of poly-myxin B,serum creatine phosphokinase showed a downward trend and normalized.This dose-independent adverse reac-tion was a new rare class B adverse reaction.A better under-standing of rare adverse reactions helps to ensure the clinical safety of polymyxin B dosing.
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