29例由注射用哌拉西林钠他唑巴坦钠引起药物热的回顾性分析

目的：为临床及时、准确地判断是否由药物引起的发热提供参考，促进临床合理用药。方法：对2015年1月-2018年12月由临床上报的41例由注射用哌拉西林钠他唑巴坦钠引起的不良反应中进行筛选，挑选出发热病例共29例，其中23例发热在38.5℃以上。对这29份病例从临床表现、用药情况、实验室检查结果、临床处理方式、转归时间等方面进行回顾性统计分析。结果：29份病例有20份是男性、9份是女性，年龄在30~70岁之间，连续用药时间超过5 d以上容易引起大于38.5℃的高热，大多数伴有寒战或恶寒的体征，实验室检查包括嗜酸性粒细胞、BCR、血清C反应蛋白（CRP）、降钙素原（PCT）等正常或不变或下降，一般都会给予退热药对症处理，停药后1~2 h体温逐渐下降，2~24 h降至正常，寒战或恶寒症状会随着体温好转而消失，换用其他药物不会再出现发热。结论：性别有一定的影响；年龄无明显规律，但青少年较少；没有特异性的实验室诊断标准，但与用药时间、累积天数存在一定的相关性，可以结合临床症状、用药时间、参考实验室指标判断是药物热还是继发性感染。临床医师应注意抗菌药物的合理使用，根据治疗情况及时停药或更换药物。

A retrospective analysis of drug fever caused by piperacillin sodium and tazobactam sodium for injection

OBJECTIVE To provide reference for the clinical diagnosis of drug-induced fever in a timely and accurate manner and to promote the rational use of drugs in clinical practice. METHODS 41 cases of adverse reactions caused by piperacillin sodium and tazobactam sodium for injection from January 2015 to December 2018 were screened. A total of 29 cases of fever were selected, of which 23 cases had fever above 38.5℃. The clinical manifestations, condition of drug use, laboratory examination results, clinical treatment and time of recovery of these 29 cases were analyzed retrospectively.RESULTS 20 of 29 cases were male and 9 were female aged between 30 and 70. Over 5 days of continuous medication was opt to induce fever above 38.5℃ with most of which accompanied by rigor and chills. Laboratory tests included eosinophils, BCR, serum C-reactive protein (CRP), procalcitonin (PCT), etc. were normal or unchanged or decreased. In general, antipyretics were given for symptomatic treatment. After drug withdrawal, the body temperature gradually decreased for 1-2 h and retured to normal for 2-24 h. The symptoms of chills or aversion to cold disappeared as the body temperature improved.CONCLUSION Gender has certain influence; age has no obvious pattern, but there are fewer patients among adolescents; there is no specific laboratory diagnostic criteria, but there is a certain correlation with medication time and cumulative days, which can be combined with clinical symptoms, medication time and reference laboratory indicators to determine whether it is drug fever or secondary infection. Clinicians should pay attention to the rational use of antibiotics and stop or replace them in time according to the situation.