摘要
目的:分析多黏菌素B致神经毒性不良反应的临床特点与发生机制,为多黏菌素B的安全合理使用提供参考。方法:选取实际工作中遇到的和从国内外权威数据库检索到的17例多黏菌素B致神经毒性不良反应病例作为研究对象,分析这些不良反应的临床点与发生机制。结果:17例病例的神经毒性不良反应均系发生在使用多黏菌素B的30 d内,其中有11例系发生在用药当天;神经毒性不良反应的主要临床表现有外周感觉异常、呼吸窘迫、心脏骤停、昏迷、眩晕、癫痫发作和横纹肌溶解等;不良反应发生后,经进行对症治疗(7例)、停药(4例)和调整治疗方案(6例),有14例患者症状缓解或消失,有3例结局为死亡。结论:多黏菌素B所致神经毒性不良反应可能产生较为严重的后果,其发生机制可能与氧化应激、线粒体功能障碍、炎症反应等有关,而使用过程中的药物联用、用药剂量、药物浓度和输注速度等因素可能具有诱发作用,故临床在用到多黏菌素B时应注意用药的规范、合理,以避免或减少不良反应的发生。
Objective:To analyze clinical characteristics and occurrence mechanism of polymyxin B-induced neurotoxic adverse reactions,and to provide reference for safe and rational use of polymyxin B.Methods:17 cases of polymyxin B-induced neurotoxic adverse reactions occurred in real work and retrieved from authoritative databases at home and abroad were selected as study subjects,and clinical characteristics and occurrence mechanism of these adverse reactions were analyzed.Results:Neurotoxic adverse reactions in 17 cases occurred within 30 d of polymyxin B administration,of which 11 cases occurred in the day of administration.Neurotoxic adverse reactions have major clinical manifestations of abnormal peripheral sensation,respiratory distress,cardiac arrest,coma,dizziness,epileptic seizure and rhabdomyolysis,etc.For the adverse reactions,after symptomatic treatment(7 cases),drug withdrawal(4 cases)and adjustment of treatment regimen(6 cases),symptoms relieved or disappeared in 14 patients,and 3 cases ended in death.Conclusion:Polymyxin B-induced neurotoxic adverse reaction may cause relatively serious consequences,and its occurrence mechanism may be related to oxidative stress,mitochondrial dysfunction,inflammatory response,etc.,while drug combination,dose,drug concentration and infusion speed during the drug use may induce the reaction,so polymyxin B should be normatively and rationally used clinically to avoid or reduce adverse reactions.
作者
管玉
汤柳星
潘杰
GUAN Yu;TANG Liu-xing;PAN Jie(Pharmacy Department,The Second Affiliated Hospital of Soochow University,Suzhou Jiangsu 215004,China)
出处
《抗感染药学》
2022年第7期1059-1064,共6页
Anti-infection Pharmacy
基金
苏州大学附属第二医院科研预研基金资助项目(编号:SDFEYQN1916)
关键词
多黏菌素B
神经毒性不良反应
临床特点
合理用药
polymyxin B
neurotoxic adverse reaction
clinical characteristic
rational drug use
