摘要
目的：回顾性分析哌拉西林他唑巴坦钠致药物热的临床表现、影响因素，为临床抗感染治疗过程中及时、准确判断药物热，避免过度、联用或盲目升级使用抗菌药物提供参考。方法对2013年9月至2014年9月四川省第四人民医院、四川省人民医院及中国人民解放军海军机关医院临床药学科（室）收集的30例由哌拉西林他唑巴坦钠致药物热患者的用药情况、临床表现、实验室检查、处理方式等进行统计分析。结果哌拉西林他唑巴坦钠致药物热多发生在连续用药7~14 d，单位累积量多在1.3~2.7 g/kg；患者均在滴注期间或结束数小时内发热，以38.5~40℃高热为主，大多数患者血白细胞、中性粒细胞正常，C反应蛋白（ CRP ）正常或轻度升高，部分患者嗜酸性粒细胞轻度升高；部分患者伴畏寒寒战、乏力，多数患者无明显其他不适症状，停用致热药物后体温均在24~48 h降至正常；临床医生普遍对药物热了解和重视程度不够，客观上也不利于药物热的正确诊断。结论哌拉西林他唑巴坦钠致药物热并无明确诊断标准，但通过对患者发热时间及症状与用药时间、单位累积量的相关性分析，结合血常规、CRP等实验室指标综合考虑，可为临床药物热的判断提供有益的参考；对于使用哌拉西林他唑巴坦钠抗感染治疗好转的患者，如疗程中再次出现发热，应注意综合判断、排查药物热的可能性；临床药师应充分利用专业优势，协助临床医师在药物热的诊断和促进临床合理用药中发挥积极作用。
Objective To retrospectively analyze the clinical manifestations, influencing factors of drug fever induced by piperacillin-tazobactam to provide reference for timely and accurately judging drug fever and avoiding excessive, combination or blindly upgrade use of antibacterial drugs during anti-infective treatment process. Methods Totally 30 cases of piperacillin-tazobactam induced drug fever collected in these 3 hospitals from September 2013 to September 2014 were performed the retrospectively statistical analysis on the medication situation, clinical manifestaions, laboratory detection and treatment modes. Results The majority of piperacillin-tazobactam in-duced drug fever occurred on 7-14 d of consecutive medication, the unit cumulative amount was generally between 1. 3- 2. 7g/kg. All patients had a fever during infusion or within some hours after infusion, and most of them had a hyperpyrexia of 38. 5-40 ℃, in which most patients had normal blood leukocytes and neutrophils and normal or mildly elevated CRP, and eosinophils in some pa-tients were mildly increased;some patients were accompanied by chills, shivering, fatigue, most patients had no other obvious uncomfort-able symptoms. The temperature of the patients would drop to the normal level after withdrawal drug within 24-48 h. In generally clin-icians had little understanding and pay attention to drug-fever, which was not conducive to the correct diagnosis of drug fever. Conclusion Piperacillin-tazobactam induced drug fever has no specific diagnostic criteria, but analyzing the fever time, medica-tion time and unit cumulative amount of drug, and combining with the comprehensive consideration of blood routine, CRP and other lab-oratory indexes can provide beneficial reference for judging drug fever. Clinicians should pay attention to the comprehensive judgment and screening the possibility of drug fever for the patients with infectious symptoms improvement by piperacillin-tazobactam anti-in-fective therapy appearing fever again. Clinical pharmacists should make full use of the professional advantages, and play a positive role in assisting clinicians in the diagnosis of drug fever and promoting rational drug use in clinic.
出处
《中国药业》
CAS
2015年第13期49-51,共3页
China Pharmaceuticals
