左氧氟沙星致低血糖

1例57岁女性患者因直肠黑色素瘤切除术后感染,给予左氧氟沙星注射液0.2 g/100 ml静脉滴注,2次/d,用药约20 min时患者出现乏力、盗汗、心悸等症状,急查血糖,为2.7 mmol/L.立即停用左氧氟沙星,静脉滴注10％葡萄糖500 ml,同时进食糖果,上述症状缓解.次日,再次静脉滴注左氧氟沙星约10 min后上述症状复现,即时血糖2.8 mmol/L.再次停用左氧氟沙星并给予对症治疗,症状缓解.改用其他抗生素治疗,患者感染得到控制,未再出现低血糖反应.     

左氧氟沙星致谵妄

患者男性,26岁.因肺炎静脉给予左氧氟沙星0.3 g,2次/d治疗.3 d后出现失眠,短暂的言语混乱.第5天出现极度兴奋,行为异常,不能入睡.给予地西泮治疗,次日停用左氧氟沙星,患者症状逐渐好转,停药24 h后恢复正常状态.     

左氧氟沙星致过敏性休克

患者男,46岁。因咳嗽、咳痰3d,于2003年8月28日就诊。既往患过肺炎,陪同人介绍患者对阿齐霉素(泰力特)过敏,家族中母亲有青霉素过敏史。查体:T36℃,BP112/80mmHg(1mmHg=0.133kPa),HR68次·min-1,双肺呼吸音粗糙,未闻及湿性啰音夭縓光片示双肺纹理粗重,痰涂片镜检发现有支原体/衣原体包涵体,上皮细胞内有大量厌氧杆菌和少量纤毛菌。诊断:支气管炎。治疗:左氧氟沙星(利复星)注射液0.2g,bid静滴;甲硝唑注射液250ml,bid静滴。11:20开通液路时,即见患者气促、胸闷、烦躁不安、恐惧、皮肤潮红,迅速拔除液路。肌注肾上腺素0.5mg、地塞米松5mg…     

盐酸左氧氟沙星致过敏性休克

患者男,43岁。因恶心、呕吐,于2002年7月29日来我院急诊室就诊。查体:BP130/80mmHg(1mmHg=0.133kPa),R20次/min,P80次/min,WBC11.1×109/L。诊断:呕吐原因待查。给予盐酸左氧氟沙星0.3g 0.9%氯化钠注射液100mL静脉滴注。当静滴1min后,患者出现全身麻木感,瘙痒,胸闷,面部、躯干潮红,BP90/60mmHg。立即停药,给予肾上腺素0.5mg皮下注射,地塞米松5mg、10%葡萄糖酸钙注射液10mL入莫非氏管。10min后患者呼吸困难,呼之不应,血压测不出,R8～10次/mim,患者昏迷,口唇发绀。给予尼可刹米0.375g入莫非氏管,多巴胺80mg静滴。患者病情逐渐加重,呼吸…     

左氧氟沙星可致精神障碍

左氧氟沙星属于第三代喹诺酮类广谱抗菌药,是治疗感染性疾病的重要药物。2005年北京市5500余例由抗生素引起的不良反应中,喹诺酮类药物占38.1%。左氧氟沙星虽为喹诺酮类抗菌药中较为安全的品种,但近几年来,随着在临床上的广泛应用,有关其不良反应的报道也日趋增多。     

左氧氟沙星静脉滴注致喉头水肿

患者女,46岁,因阴道出血15d、加重5d、伴乏力、心慌等不适,于2005年10月20日来本院就诊。妊娠实验(HCG)阴性。诊断:阴道出血,原因待查。治疗措施:5%葡萄糖注射液250ml+左氧氟沙星0.4g;5%葡萄糖注射液250ml+止血芳酸0.4g+维生素C2.0g;0.5%甲硝唑200ml,静脉滴注,滴速均为50滴/min,1次/d。首先输注5%葡萄糖注射液250ml+左氧氟沙星0.4g组,1min后,病人自感喉部不适,随即声嘶、呼吸困难,怀疑为左氧氟沙星所致喉头水肿,立即停药,给予吸氧,地塞米松10mg静脉推注,0.1%肾上腺素0.5mg肌内注射,测BP120/80mmHg(1mmHg=0.133kPa),P80次/min,R30次/min…     

左氧氟沙星致严重过敏

患者女,53岁。欲于局麻下行踝关节螺丝钉取出术,于2003年6月25日上午10:30入急诊手术室。患者既往有风湿性关节炎病史,无心脏病、高血压等病史,亦无其他药物过敏史。手术前开放静脉,输注林格氏液。11:10为预防术后感染给予盐酸左氧氟沙星(易路美)0.2g溶于0.9%氯化钠注射液100ml中,慢速滴注。输入盐酸左氧氟沙星约10～20ml时,首先发现患者不能配合,继而全身抽搐,呼之不应,牙关紧闭,呼吸暂停,口唇紫绀。血气分析:pH7.24,PaCO245mmHg,PaO293mmHg,剩余碱分析(BE)11mmol·L-1,SpO275%,立即停药。给予面罩加压给氧,地西泮10mg静注,地塞米松1…     

左氧氟沙星致出血性膀胱炎

1例52岁女性患者因急性扁桃体炎口服左氧氟沙星0.2 g,3次/d。3 d后出现尿急、尿频、下腹痛,棕色尿液,尿中见血块,伴有排尿困难。实验室检查示尿隐血(+++)。超声检查提示急性膀胱炎。停用左氧氟沙星。停药第2天,尿色逐渐恢复正常。第5天尿常规结果正常。2用后超声检查示膀胱恢复正常。     

左氧氟沙星静滴致过敏性休克

患者女,23岁.因腹痛、腹泻1d,于2001年5月13日来我院急诊科就诊,诊断为急性胃肠炎.给予静脉滴注左氧氟沙星注射液100ml,滴速为30滴·min-1.患者于用药后5min,出现头晕、胸闷、四肢麻木.     

左氧氟沙星致球结膜水肿

患者男,54岁。因头痛、鼻塞伴腹泻1d,于2005年1月9日来院就诊。患者既往无特殊病史及药物过敏史。查体:T36.4℃,P80次/min,R16次/min,BP120/70mmHg(1mmHg=0.133kPa)。全身各系统未见异常。血常规:WBC4.85×109/L,N0.677,L0.223,M0.082,E0.016,Hb155g/L,PLT168×109/L。诊断:上呼吸道感染(胃肠型)。给予左氧氟沙星0.3g加入5%葡萄糖氯化钠注射液500mL中静滴,滴速40滴/min。静滴10min时,患者感双眼发痒不适,似有突出感,未予重视。静滴1h,患者感到双眼肿胀,有明显异物感,无皮肤搔痒、发红,亦无心慌、胸闷等,视力无改变。查体:T36.8℃,…     

自身腹水超滤浓缩回输腹腔或静脉治疗肝硬化腹水疗效观察

目的观察自身腹水超滤浓缩腹腔和静脉回输腹腔和静脉治疗肝硬化腹水疗效。方法选取笔者所在医院收治的肝硬化腹水患者32例,随机分为Ⅰ组腹水超滤浓缩回输腹腔组,Ⅱ组腹水超滤浓缩回输静脉组。观察治疗后2周及4周24h尿量、血白蛋白、尿素氮、肌酐、不良反应及腹水减少百分比。结果治疗后2周,Ⅱ组患者24h尿量、血白蛋白、不良反应百分比较Ⅰ组患者显著增高,尿素氮较Ⅰ组患者显著下降(P<0.05);两组肌酐、不良反应比较,差异无统计学意义(P>0.05)。治疗后4周,Ⅱ组患者血白蛋白较Ⅰ组患者显著增高(P<0.05)。结论腹水超滤浓缩回输腹腔和静脉治疗效果差异无统计学意义,临床可根据患者不同情况选择应用。     

Medical management of ascites

INTRODUCTION: Ascites is a common complication of advanced cirrhosis that has a significant negative impact on survival. This review updates the reader on the medical management of ascites. AREAS COVERED: This review explores the pathophysiology of ascites formation in cirrhosis; the current mainstays of medical management (treating the underlying cause of cirrhosis, avoiding nephrotoxic agents, sodium restriction, and combination diuretic therapy); potential novel agents, such as vasoconstrictors and vaptans; and albumin infusions. The literature research covers all aspects of medical management of ascites from the English literature, concentrating on publications from the past 10 years. It provides a thorough understanding of how the correction of pathophysiology of ascites formation helps to improve ascites; knowledge on the monitoring of patients with cirrhosis and ascites receiving medical management, and on prophylaxis against potentially life-threatening complication such as spontaneous bacterial peritonitis; and potential new treatments for ascites. EXPERT OPINION: Management of patients with cirrhosis and ascites requires careful attention to fluid and electrolyte balance and avoidance of complications. Recognition of refractory ascites allows for the use of second-line treatments. All patients with cirrhosis and ascites should be considered for liver transplantation.     

Management of cirrhotic ascites

The pathogenesis and diagnosis of cirrhotic ascites are reviewed, and the treatment options are described, focusing on pharmacologic management. The major theories on the pathogenesis of cirrhotic ascites are the underfill and overflow theories. The underfill theory states that ascites formation results in decreased plasma volume leading to renal sodium and water retention. The overflow theory states that the initial event in ascites formation is renal sodium retention. Evidence suggests that the formation of ascites is a continuum involving both overflow (early) and underfill (late) mechanisms. Although the most frequent cause of ascites is hepatic cirrhosis, analysis of the ascitic fluid is important to exclude other causes (e.g., neoplasm, peritonitis, pancreatitis). Patients who do not respond to treatment with sodium restriction and bed rest require diuretic therapy. Spironolactone is the agent of choice for treatment of the nonazotemic patient with cirrhotic ascites. Combination therapy with spironolactone and furosemide or spironolactone and metolazone may be used in those patients who do not respond to spironolactone. Patients with impaired renal function should not be treated with spironolactone because of the risk of hyperkalemia. Paracentesis with albumin replacement has been used successfully for treatment of patients with tense cirrhotic ascites. Initial management of cirrhotic ascites is conservative, with sodium restriction and bed rest. Spironolactone is a good first-choice drug for treatment of ascites. Daily weight, serum electrolytes, and renal function should be monitored to assess the effectiveness and potential adverse effects of diuretic therapy.     

联机腹水浓缩回输在尿毒症顽固性腹水中的应用

目的　探讨联机腹水浓缩回输对尿毒症顽固性腹水的疗效及安全性。方法　对 16例维持性血液透析伴有顽固性腹水的患者 ,在血液透析的过程中将腹水引流到血透体外循环 ,同步进行腹水超滤、浓缩回输静脉 ,并观察治疗前后体重、腹围、尿量、腹水B超探测值改变情况以及测定血浆白蛋白、肾功能、电解质水平。每次治疗量 30 0 0～ 6 0 0 0ml,共计 5 2例次。结果　腹水回输治疗后与治疗前比较 ,患者腹围、体重有明显下降 ,B超探测腹水量减少 ,尿量明显增加 ,血浆白蛋白含量显著增加 (P均 <0 0 1) ,而血清电解质水平无明显 (P >0 0 5 )。血清肌酐和尿素氮的下降率分别达到 5 2 16 %± 6 32 %和 5 8 93%± 7 5 1%。不良反应有热源反应 5例次 ,血性腹水 3例次 ,滤器部分堵塞报警及一过性心力衰竭各 2例次 ,仅需一般性对症处理即可纠正 ,治疗过程未影响。结论　血液透析和腹水回输同步进行可达到腹水浓缩回输和清除代谢产物的双重效果 ,操作安全 ,具有良好的临床应用价值     

自体腹水浓缩回输腹腔治疗顽固性腹水的临床研究

目的观察自体腹水浓缩腹腔回输术治疗顽固性腹水的效果.方法26例经常规治疗无效的顽固性腹水患者,在原治疗基础上加用腹水浓缩腹腔回输治疗,于腹水回输前后观察腹围、尿量、血生化及腹水蛋白改变.结果治疗后所有患者腹围减少,尿量增加,腹水明显减少或消失,血清总蛋白、白蛋白、腹水蛋白均升高(P＜0.01),血钾、钠、氯无明显变化(P＞0.05).结论腹水浓缩腹腔回输对治疗顽固性腹水有良好效果.     

腹水浓缩回输术治疗顽固性肝硬变腹水的临床观察

目的 为解除或减缓肝硬变患临床腹水症状所致的痛苦。方法 对患自身腹水经超滤浓缩后，并联合甘露醇，速尿加压静滴回输。结果 本组显效5例，有效3例．总有效率72．72％。结论 腹水脓缩回输术，既可清除患腹水，又无需另外补充白蛋白，联合使用甘露醇、速尿．可增加利尿效果．临床效果较好。     

Catumaxomab: in malignant ascites

Catumaxomab is a rat/murine hybrid, trifunctional, bispecific (anti-human epithelial cell adhesion molecule [EpCAM]?×?anti-CD3) monoclonal antibody. Compared with paracentesis alone, paracentesis followed by catumaxomab therapy was associated with significant prolongation of paracentesis-free survival and time to repeat paracentesis in a randomized, open-label, multicentre, pivotal phase II/III trial in patients with recurrent symptomatic malignant ascites due to EpCAM-positive tumours who were resistant to conventional chemotherapy. The benefits of catumaxomab were seen across a broad range of epithelial ovarian and nonovarian cancers, and irrespective of whether or not catumaxomab recipients developed human anti-mouse antibodies. Combining catumaxomab with paracentesis also resulted in more pronounced and prolonged reductions in ascites signs and symptoms and a delayed deterioration in health-related quality of life compared with paracentesis alone. Despite the study not being designed or powered to evaluate overall survival, significant differences favouring the addition of catumaxomab to paracentesis were seen in analyses of the safety population and the subpopulation of patients with gastric cancer. Catumaxomab was generally well tolerated in the pivotal phase II/III trial. The most frequent adverse events attributed to catumaxomab treatment included cytokine-release-related symptoms, which were mostly of mild to moderate severity and manageable with standard symptomatic treatment.     

Penetration of cefoperazone into ascites

Summary The pharmacokinetics of cefoperazone was studied in eleven cirrhotic patients with ascites after i.v. administration of a single dose of 15 mg·kg^–1 (n=7) or after three doses of 15 mg·kg^–1 given at 12 h intervals (n=4). The concentrations of cefoperazone in serum and ascitic fluid were determined by HPLC. The peak serum cefoperazone concentration after a single i.v. injection of 15 mg·kg^–1 was 96.0 mg·l^–1. The serum elimination half-life was longer (5.0 h) than in normal subjects. The penetration of cefoperazone into ascites was satisfactory (32.3% and 58.3% after single and repeated injections, respectively).Ascitic fluid concentrations of cefoperazone exceeded 5.4 mg·ml^–1 from 0.5 to 6 h after the single i.v. injection, levels which are well above the MIC of most pathogens found in spontaneous bacterial peritonitis. Adjustment of the dose of cefoperazone in cases of severe hepatic insufficiency does not appear to be necessary provided that renal function is normal.     

242例血清-腹水白蛋白梯度检测鉴别腹水性质的临床意义

目的探讨研究血清-腹水白蛋白梯度检测对诊断腹水性质的临床意义。方法本院自2005年10月至2008年10月收治的242例腹水患者以彩色多普勒超声测定门静脉内径〉14mm提示门静脉高压,分为门静脉高压组130例和非门静脉高压组112例进行血清-腹水白蛋白梯度检测。结果门静脉高压组SAAG（17．8±4．7）g／L,符合率96．15％;非门静脉高压组SAAG（8．2±3）g／L,符合率95．53％。结论SAAG检测操作方法简单,与门脉高压相关性好,具有更强的实用性及更广泛的应用价值．有助于更容易鉴别积液的性质,在腹水病因诊断中具有重要的临床价值。