注射用哌拉西林钠他唑巴坦钠致药物热的临床分析

摘要

OBJECTIVE:To provide reference for the timely and accurate judgment of drug fever induced by Piperacillin sodi-um and tazobactam sodium for injection and rational drug use in the clinic. METHODS:The medication,clinical manifestations, laboratory examination results and the physician treatment of 30 inpatients with drug fever induced by Piperacillin sodium and tazo-bactam sodium for injection from Sept. 2013 to Sept. 2014 were analyzed retrospectively and statistically. RESULTS:Most of the drug fever induced by Piperacillin sodium and tazobactam sodium for injection occurred in continuous 7 to 14 d medication,and the cumulative dosages were between 1.3 to 2.7 g/kg;73.3% of the 30 patients had fever during the intravenous drip,with body temperature mainly≥38.5 ℃;the elevation of eosinophil and slightly increase of serum C-reactive protein (CRP) and blood cell sedimentation rate (ESR) could be used as observation indexes of drug fever,but the leucocyte reduce could’t be suitable;the body temperature dropped to normal within 24 to 48 hours after stopped using it. CONCLUSIONS:The drug fever induced by Piperacillin sodium and tazobactam sodium for injection has no correlation with the patients’gender or age,and no special diagnos-tic criteria. But it has certain correlation with duration of medication,cumulative days and dosages and it can be used as reference of judgment with the combination of hematological examination index. Clinicians should improve the understanding and attention about drug fever to stop using suspicious drug in time.%目的：为临床及时、准确地判断注射用哌拉西林钠他唑巴坦钠引起的药物热和合理用药提供参考。方法：对2013年9月－2014年9月临床药师收集的30例由注射用哌拉西林钠他唑巴坦钠致药物热住院患者的用药情况、临床表现、实验室检查结果、医师处理方式等进行回顾性统计分析。结果：注射用哌拉西林钠他唑巴坦钠致药物热多发生在连续用药7～14 d，单位累积用量多在1.3～2.7 g/kg之间；30例患者中，73.3％在滴注期间开始发热，体温以≥38.5℃高热为主；嗜酸性粒细胞计数升高、血清C反应蛋白（CRP）和血细胞沉降速率（ESR）轻度升高可作为药物热的判断指标，但白细胞计数降低并不适合作为判断指标；停用该药或改用其他抗菌药物后，患者体温均在24～48 h内降至正常。结论：注射用哌拉西林钠他唑巴坦钠致药物热与患者性别、年龄没有关联，也没有特异性的诊断标准，但与用药时间、累积天数、单位累积用量存在一定的相关性，结合一些血液学检查指标可作为判断药物热的依据。临床医师应提高对药物热的认识和重视程度，及时停用可疑药物。