社区使用头孢拉定引起19例儿童血尿的临床分析

Clinical analysis of 19 children with hematuria induced by cefradine use in the community

目的:分析头孢拉定静脉滴注致儿童血尿的原因。方法:收集2005年3月至2008年3月社区使用头孢拉定致19例儿童血尿的临床资料。对患者的性别、年龄及临床表现,头孢拉定的用法用量,血尿出现的时间和严重程度以及转归进行调查分析。结果:19例患儿中男16例,女3例,年龄≤1岁3例,～3岁10例,～7岁4例,>7岁2例。头孢拉定常规用法用量为50～100mg/(kg.d)溶于0.9%氯化钠或5%葡萄糖注射液100～250ml中静脉滴注。剂量为100mg/(kg.d)16例,>110mg/(kg.d)1例,<100mg/(kg.d)2例。有17例将1日剂量作1次量给予。19例中,肉眼血尿17例,镜下血尿2例。实验室检查示红细胞(+++～++++)/HP,尿蛋白定量<0.1g/24h。肾功能正常者16例(84.2%),肌酐、尿素氮轻度升高者3例(15.8%)。血尿出现于用药后24h内18例(94.7%),>24h1例(5.3%)。经停药治疗后,肉眼血尿于1～2d消失,镜下血尿于3～5d消失。出院随访3个月,患者尿常规与肾功能均正常。结论:头孢拉定静脉滴注致儿童血尿可能与大剂量。

Objective： To investigate the causes of cefradine-induced hematuria in children. Methods： Clinical data from 19 children with hematuria induced by cefradine use in the community from March 2005 to March 2008 were collected. The patients＇ sex and age, clinical presentation, dosage and administration of cefradine, the onset time, intensity and outcome of hematuria were investigated and analyzed. Results： Of the 19 children, l6were males, 3 were females, and their age was ≤ 1 year （3 cases）, -3 years （ 10 cases）, - 7 years （4 cases） , and 〉 7 years （ 2 cases）. The routine dosage of cefradine was 50 - 100 mg/（ kg · d） dissolved in 100 - 250 ml of sodium chloride 0. 9% or glucose 5% for an IV infusion. Sixteen patients received 100 rag/（ kg · d）. One patient received 110 mg/（kg · d）, two patients received 〈 100 mg/（kg · d）. The daily dosage was used as a single dose in 17 patients. Of the 19 patients, 17 developed gross hematuria and two developed microscopic bematuria. Laboratory tests showed RBC （ ＋ ＋ ＋ - ＋ ＋ ＋ ＋ ）/HP and urinary protein 〈0.1 g/24 h. Sixteen patients （84.2%） had normal renal function and 3 patients （ 15.8% ） had mild elevation in SCr and BUN levels. Eighteen patients （ 94.7% ） developed hematuria within 24 hours after receiving drug therapy. One patient＇s hematuria onset was over 24 hours. After drug withdrawal, gross hematuria disappeared within 1 - 2 days and microscopic hematuria disappeared within 3 -5 days. At 3-month follow-up after discharge, their routine urine and renal functions normalized. Conclusion： Hematuria following an IV infusion of cefradine in childnen might be linked to the factors of large dose, high concentration, and young age.