替加环素相关急性胰腺炎

替加环素(tigecycline)是一种新型广谱抗生素,为甘氨酰环素类(glycyclines)抗生素的首个药物,其化学结构与四环素相似.替加环素对革兰阳性菌和革兰阴性菌具有抗菌活性,用于治疗复杂皮肤、软组织感染和复杂腹腔内感染.通常,替加环素偶致急性胰腺炎,但近年资料表明,替加环素致急性胰腺炎有所增加.临床表现主要为恶心、呕吐、腹痛、腹胀以及血清脂肪酶和淀粉酶水平升高.替加环素致胰腺炎的机制尚不明确,但由于替加环素的结构与四环素结构相似,推测替加环素是通过四环素致胰腺炎的同样机制引起急性胰腺炎.替加环素若引起胰腺炎,应立即停药,保持患者禁食状态,静脉给予足量液体,并给予其他对症治疗.替加环素使用期间,临床医师应密切观察患者有无胰腺炎的症状和体征,监测患者的血清脂肪酶和淀粉酶水平.     

替加环素对重症急性胰腺炎患者肝功能、淀粉酶及凝血功能的影响

目的:分析替加环素对重症急性胰腺炎患者肝功能、淀粉酶及凝血功能的影响,为合理使用替加环素提供参考.方法:回顾性选择某院2017年6月至2019年5月期间使用替加环素治疗的重症急性胰腺炎患者,共纳入51例.根据用药前总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱...     

文献报道的替加环素诱发肾移植患者急性胰腺炎11例分析

摘要：目的:探究文献报道的替加环素致肾移植术后患者急性胰腺炎的特点,为肾移植术后患者使用替加环素的安全提供参考。方法:检索国内外数据库中收录的替加环素诱发肾移植术后患者急性胰腺炎的个案报道,对纳入文献中患者基本信息及出现不良反应(ADR)情况进行统计分析。结果:共纳入11个病例,其中男8例,女3例,平均年龄(42.82±11.36)岁;10例患者合并使用免疫抑制药;9例(81.82%)患者的ADR诱导期在10d以内,8例(72.73%)患者初期临床表现主要是腹痛,6例(54.54%)为恶心、呕吐、腹胀;除1例未报道外,其他患者的血清淀粉酶和脂肪酶均高于正常值。所有患者均停药、对症处理,(3.56±1.26)d后临床症状逐渐改善,(6.3±5.06)d后血清淀粉酶和脂肪酶水平恢复正常。结论:肾移植术后患者使用替加环素应慎重,一旦发生急性胰腺炎需立即停药并对症处理。     

替加环素致构音障碍一例

本文报道1例急性复杂性腹腔感染IgA肾病患者经替加环素抗感染治疗后出现构音障碍的案例。患者经替加环素治疗后出现构音障碍,经临床药师参与对其症状与药物关联性进行分析,建议医师对患者进行血液灌流,同时替加环素减量,经过这一治疗后患者构音障碍好转,停用替加环素后构音障碍逐渐消失。肾功能不全患者及低蛋白血症患者使用替加环素应警惕药物浓度偏高引起不良反应。     

1例替加环素致肝受损的病例分析

替加环素是一种新型的广谱抑菌药物,其拥有超广谱的抗菌活性,于2011年12月在我国上市,其与四环素的机构极为相似,且不易产生耐药性。替加环素具有广泛的抑菌活性,在多种疾病中发挥显著的抑菌效果,但随着抗生素的滥用,导致多重耐药菌重现,Ⅲ期临床试验已证实替加环素最常见的不良事件是胃肠道反应,如恶心、呕吐(20%～45%)、胰腺炎及胆红素、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)等血清水平的升高等,但随着其临床使用日渐增多,不良反应逐渐增多,此外,部分患者使用替加环素会发生肝功能异常等不良反应,这大大降低了替加环素的使用范围。如果出现严重肝功能损伤应立即停药并及时纠正,加用保护肝功能药物,以免引起急性重症药物肝损伤。     

替加环素不良反应回顾性分析

目的提高对替加环素不良反应的认识,为临床合理用药提供参考.方法：通过检索文献,对替加环素不良反应病例中患者一般情况、原患疾病、不良反应类型、不良反应发生时间、治疗方法及转归等进行分析,同时报道1 例使用替加环素后引起低血糖反应患者的诊疗过程,并结合文献进行分析.结果：共检索出10 例替加环素不良反应的个案报道,其中胰腺炎8 例,腹泻1 例,凝血功能异常1 例.本文报道的1 例78 岁男性患者诊断为重症肺炎、慢性阻塞性肺疾病、肺间质纤维化,机械通气过程中,痰培养多次为多重耐药鲍曼不动杆菌,在使用替加环素静脉滴注后出现顽固性低血糖.结论：应用替加环素时,应高度警惕其不良反应的发生,确保安全用药.     

替加环素治疗心脏外科术后泛耐药鲍曼不动杆菌感染的回顾性病例分析

摘要：目的:了解替加环素(200 mg·d-1)在心脏外科术后泛耐药鲍曼不动杆菌（XDRAB）感染中的使用情况。方法:调取2017年1月～2019年12月医院心脏大血管外科监护病房使用替加环素的病例,对感染部位、致病菌及药敏情况,以及替加环素给药方案、临床疗效、不良反应等进行回顾性分析。结果:收集到相关病例共50例,其中肺部感染46例,血流感染4例。治疗方案分别为替加环素联合含舒巴坦制剂（36例）和替加环素联合碳青霉烯类药物（14例）。50例患者的临床有效率为60.0%（30/50）,细菌清除率为46.0%（23/50）;替加环素+含舒巴坦制剂组临床有效率和细菌清除率均优于替加环素+碳青霉烯组（P<0.05）。共发生替加环素相关不良反应10例,包括肝功能损害5例,以胆汁淤积型为主,其次是血清淀粉酶和脂肪酶升高（2例）、凝血功能障碍（2例）和胰腺炎1例。结论:治疗心脏外科手术后XDRAB感染,替加环素(200 mg·d-1)联合含舒巴坦制剂方案有效性优于联合碳青霉烯方案;替加环素不良反应发生率较高,临床应高度警惕肝功能异常、凝血功能异常、胰腺炎等不良反应的发生。     

无创机械通气在重症急性胰腺炎中的应用

目的观察重症急性胰腺炎并发急性呼吸衰竭患者应用无创呼吸机辅助通气（Non invasive ventila-tion,NIV）后的临床疗效,为进一步研究重症急性胰腺炎的治疗方法奠定基础。方法对69例重症急性胰腺炎患者在常规治疗仍并发低氧血症时加用无创通气,检测应用前后的呼吸频率（RR）与动脉血氧饱和度（SpO2）、动脉血氧分压（PaO2）、pH、氧合指数（O I）等参数,观察其临床疗效。结果51例经加用NIV治疗后RR明显减慢（P〈0.05）、SpO2、PaO2和氧合指数等均明显改善（P〈0.05）,pH恢复正常（P〈0.05）。结论无创通气治疗重症急性胰腺炎并发急性呼吸衰竭患者可有效改善患者的呼吸状态,促进呼吸功能的恢复,是抢救早期重症急性胰腺炎患者安全有效的治疗方法。     

急性重症胰腺炎并发腹腔高压的监测和护理体会

目的监测急性重症胰腺炎并发腹腔高压的临床表现,并探讨临床护理体会。方法选取我院收治的40例急性重症胰腺炎并发腹腔高压患者为研究对象,观察40例患者急性重症胰腺炎并发腹腔高压患者炎性反应程度,并监测患者腹内压、行血流动力学、呼吸功能等,并给予护理。结果 40例患者中,30例患者痊愈出院,10例患者因腹腔室隔综合征而死亡。结论明确急性重症胰腺炎并发腹腔高压的病情程度,针对性地改变血流动力学及心肺肾胃肠神经,采取科学合理的监测及护理手段是有效治疗急性重症胰腺炎并发腹腔高压患者的重要手段。     

替加环素在重症患者经验性抗感染治疗中的临床疗效

目的观察替加环素对重症患者经验性抗感染治疗的效果,为临床合理使用替加环素防治多重耐药菌感染及改善患者预后提供依据。方法选择2013年7月至2014年12月在我院ICU给予替加环素治疗的重症患者30例,比较替加环素治疗前后患者的体温、白细胞(WBC)及降钙素原(PCT)等临床感染指标及临床预后和并发症的发生率的变化。结果患者应用替加环素的总疗程为8.5(6~12)d,临床成功(感染症状和体征部分或完全改善)21例,临床失败(感染症状和体征无改善或恶化)9例,替加环素治疗28 d后的死亡率为20%(6/30),并发转氨酶升高2例。替加环素治疗临床成功患者用药前后APACHEⅡ和SOFA评分分别为(16.05±8.18 vs.8.61±5.50,P<0.001)和(6.76±5.18 vs.2.67±2.52,P<0.001),WBC(×109/L)和PCT(ng/m L)分别为(15.46±5.73 vs.8.81±3.44,P<0.001)和(4.88±5.73 vs.0.37±0.35,P<0.01),患者体温完全恢复正常时间为7(5~10)d。结论对可疑MDR病原菌感染的重症患者使用替加环素经验性治疗能够提高临床抗感染的成功率,进而可能改善重症患者的预后。     

Tigecycline-induced acute pancreatitis: case report and literature review

Tigecycline is a broad-spectrum antimicrobial agent structurally related to minocycline. Pancreatitis has been associated with the tetracycline class of antibiotics and concerns about tigecycline-induced acute pancreatitis have recently been raised. We describe a 69-year-old female who received tigecycline for treatment of a complicated skin and skin-structure infection. Following 7 days of tigecycline she developed severe abdominal pain and elevated pancreatic enzymes suggesting acute pancreatitis. According to the Naranjo adverse drug reaction probability scale, tigecycline was the probable cause of her acute pancreatitis. Clinicians should be aware of this potential adverse effect of tigecycline. We recommend that clinicians monitor patients for signs and symptoms of pancreatitis, including abdominal pain, during treatment with tigecycline.     

Review article: Drug-induced pancreatitis

Drugs are a relatively uncommon cause of pancreatitis in adult patients, but should be considered when other reasonable causes of pancreatitis are not present. A wide variety of drugs have been reported to cause pancreatitis. Drug–induced pancreatitis is almost always acute and may be mild to fatal in severity. Definite proof that a drug causes pancreatitis requires that pancreatitis develops during treatment with the drug, that other likely causes of pancreatitis are not present, that pancreatitis resolves upon discontinuing the drug, and that pancreatitis usually recurs upon readministration of the drug. For ethical reasons, rechallenge with the suspect drug can be done only if the drug is necessary to treat a serious condition: thus this highly convincing piece of evidence relating the drug to pancreatitis may not be available. Information about drug–related pancreatitis is often not readily available, particularly for newer drugs. Clinicians should consider obtaining information directly from regulatory agencies and manufacturers as well as the literature.     

Acute pancreatitis during lambda cyhalothrin poisoning

Abstract

There have been no case reports on lambda cyhalothrin induced pancreatitis in the literature available. In this report, we present the case of a 48-year-old female who accidentally ingested lambda cyhalothrin developed pancreatitis. The patient survived despite the development of lactic acidosis and ventricular diastolic function. Concurrent acute pancreatitis is a severe complication leading to poor prognosis. Particular attention should be paid to prevention and the early discovery and treatment of complications to improve the success rate of recovery.     

Possible drug-associated pancreatitis after paclitaxel-cremophor administration

Paclitaxel, a relatively new antineoplastic agent, is associated with numerous side effects, including two reported cases of pancreatitis. Our patient also developed paclitaxel-associated pancreatitis. Several companion drugs, including steroids, diphenhydramine, histamine2 blockers, serotonin type 3 antagonists, and other chemotherapeutic agents administered with paclitaxel, must be considered as possible causes of pancreatitis. In addition, paclitaxel is a hydrophobic agent that requires a vehicle, cremophor (CrEL), for solubility. Intravenous cyclosporine also requires CrEL and has been associated with pancreatitis. In the cerulein-induced pancreatitis rat model, paclitaxel with dimethyl sulfoxide as a vehicle prevents pancreatitis, suggesting that another causal agent is responsible. Animal studies of CrEL as a single agent may be required to settle this question, but for now, awareness that paclitaxel may be associated with pancreatitis may lead to earlier treatment of this potentially fatal complication.     

重症急性胰腺炎的诊断与治疗

目的探讨重症急性胰腺炎(SAP)更为合理的诊治方法。方法回顾64例重症胰腺炎的临床资料,结合文献分析SAP诊治的临床效果。结果本组非手术治疗38例,死亡4例,手术治疗26例,死亡3例,总病死率10.94%。结论 SAP的非手术治疗有了显著的进步,需要外科治疗的病例在逐渐减少,但应视患者临床特点制定治疗对策,不可一味追求非手术治疗或手术治疗。     

Acute pancreatitis after nifedipine and acetaminophen poisoning — case report

The incidence of drug-induced pancreatitis is rare. There have been several reports of acute pancreatitis as a complication in acute poisoning with drugs or toxins. We present a case of a young woman with acute pancreatitis secondary to an overdose of nifedipine and acetaminophen in a suicide attempt. We excluded other causes of acute pancreatitis by clinical history, serum toxicology, serology, and abdominal imaging. The most likely underlying pathophysiological mechanism was ischemic injury of the pancreas secondary to severe collapse induced by nifedipine and possible acetaminophen-induced direct pancreatotoxicity. The pancreatitis resolved with treatment that included continuous veno-venous haemofiltration in an intensive care unit. Emergency and intensive care units should be aware of this unusual complication of such poisoning. To our knowledge, this is the first reported association between massive nifedipine overdose and acute pancreatitis.     

Capecitabine-induced pancreatitis

A 47-year-old woman with metastatic breast cancer developed acute pancreatitis while receiving capecitabine. She had been receiving capecitabine 2000 mg/m2/day; however, when the dosage was increased to 2500 mg/m2/day (the maximum dosage approved by the Food and Drug Administration) she experienced abdominal pain and cramping. These symptoms were followed by nausea and vomiting, palmar-plantar erythrodysesthesia (hand-foot syndrome), and mucositis, resulting in admission to the hospital. Laboratory tests for liver function showed elevated levels of alkaline phosphatase and lactate dehydrogenase. The patient's lipase and amylase levels were also elevated, but an abdominal ultrasound was normal. After bowel rest and intravenous hydration, the patient's liver function tests and lipase and amylase levels returned to normal. Many chemotherapeutic agents have been documented to cause pancreatitis; however, we found no previously described reports of capecitabine-induced pancreatitis. Clinicians should be aware of this potential adverse effect, particularly in patients with preexisting risk factors for pancreatitis who are prescribed capecitabine.     

The development of a clinical syndrome of asymptomatic pancreatitis and eosinophilia after treatment with clozapine in schizophrenia: implications for clinical care,recognition and management

Clozapine, the first atypical antipsychotic, is indicated for the treatment of therapy-resistant schizophrenia. It needs to be monitored closely because of its well-known potential side-effects, especially agranulocytosis. We present a case of a middle-aged woman with chronic schizophrenia, who was treated with clozapine and developed a clinical syndrome of asymptomatic pancreatitis and eosinophilia within the fifth week of treatment. Asymptomatic pancreatitis has rarely been reported up to now and is not recognized as a typical side-effect of clozapine. In our opinion, pancreatic enzymes should be monitored especially in the first 6 weeks of clozapine treatment.     

急性胆源性胰腺炎79例临床分析

目的探讨急性胆源性胰腺炎（ABP）临床治疗方法及效果。方法回顾性分析79例ABP的临床资料。结果非手术治疗17例,死亡l例;手术治疗62例,治愈54例,死亡8例。结论以胆道梗阻为主的ABP应急诊手术治疗,无梗阻的ABP应先采用非手术治疗,再择期手术治疗。     

Management of acute pancreatitis in emergency

This review focuses on the medical and endoscopic approachs to patients with acute mild or severe pancreatitis. Acute pancreatitis is an acute inflammatory process of the pancreas whose the main determinant of the outcome is the extent of pancreatic necrosis. After the diagnosis, a severity assessment using scoring systems and early contrast enhanced Computed Tomography should be performed in all patients within 48 hours from the admission. All cases of severe acute pancreatitis should be managed initially in intensive care units with full systems support. Patients with gallstone pancreatitis should have definitive Endoscopic Retrograde Colangio-Pancreatography (ERCP) or surgical management of the gallstones.