头孢哌酮／舒巴坦钠对凝血功能的影响及处理

Effect of sulbactam - cefoperazone on coagulation function and the intervention

目的探讨头孢哌酮／舒巴坦钠对凝血功能的影响及处理方法。方法回顾性分析本院2008-12～2011～08入住我院的40例经头孢哌酮／舒巴坦钠治疗后出现凝血功能异常的患者的临床资料，分析其临床特点。结果40例患者平均年龄（63．8±18．7）岁，其中男性27例（67．5％），女性13例（32．5％）。原发病以肺部感染最多见，其次为下肢蜂窝织炎、肠梗阻、急性感染性心内膜炎等。应用头孢哌酮／舒巴坦钠6．0～9．0g／d3～12d后发现凝血功能异常，PTT（24．1±14．5）s，SPTT（53．0±24．0）S，INR1．70±0．90，均较用药前明显升高（P〈0．05或P〈0．01），血小板计数无明显变化（P〉0．05），部分患者出现皮肤淤斑、消化道出血及血尿等临床表现，加用维生素K1干预治疗后胛较前明显缩短（P〈0．05），APTT、INR有所缩短，但差异无统计学意义（P〉0．05）。结论常规剂量头孢哌酮／舒巴坦钠对部分患者凝血功能有一定影响，尤其老年、纳差患者在应用头孢哌酮／舒巴坦钠治疗3d后需常规监测出凝血时间，警惕出血征象。用头孢哌酮／舒巴坦钠后出现凝血功能异常者加用小剂量维生素K1治疗可明显改善凝血功能。

Objective To study the effect of sulbactam - cefoperazone on blood coagulation function and the treatment. Methods To retrospectively analyze 40 patients with dysfunction of blood coagulation after sulbactam - eefoperazone treatment from December 2008 to August 2011. Results 40 patients with an average age of （63.8 ± 18.7 ） years, male 27 cases （67.5%） , female 13 cases （32. 5% ）. Primary disease of pulmonary infection was most common, followed by eellulitis of lower extremities, intestinal obstruction, acute infectious endocarditis. Dysfunction of blood coagulation was found after sulbactam - cefoperazone of 6.0 N 9.0 grams per day for 3 - 12 days. PT （24.1 ± 14.5 ） seconds, APTT （ 53.0 ±24.0 ） seconds, INR （ 1.70 ±0.90 ） increased more significantly than before （P 〈 0. 05 or P 〈 0. 01 ）, platelet count bad no statistical significance （ P 〉 0. 05 ）. Clinical manifestations such as skin ecchymosis, hematuria, gastrointestinal hemorrhage appeared in some patients, but PT reduced more significantly （ P 〈 0.05 ） , APTT and INR bad been shortened, but the difference was not statistically significant after the intervention of vitamins K1 （ P 〉 0.05 ）. Conclusion Sulbactam -cefoperazone have an effect on blood coagulation function in some patients, especially in the elderly patients even with regular doses, so we have to monitor coagulation time. Dysfunction of blood coagulation can be improved with vitamin K1.