胺碘酮相关肺间质纤维化

Amiodarone-related pulmonary interstitial fibrosis

1例73岁男性患者,因心房颤动给予胺碘酮治疗。800mg/d静脉滴注1周后,改为口服600mg/d1个月、400mg/d2个月、200mg/d3个月。用药6个月后患者出现干咳、气促。肺CT示双肺呈间质性改变。实验室检查示:WBC22.68×109/L,N0.76,BUN11.20mmol/L,SCr182μmol/L。pH值7.36,PO235mmHg,PCO249mmHg,SaO264%。考虑为胺碘酮所致肺间质纤维化合并感染。给予面罩吸氧,左氧氟沙星0.5g静脉滴注,1次/d,头孢哌酮-舒巴坦3.0g静脉滴注,2次/d;甲泼尼龙40mg静脉滴注,2次/d及乙酰半胱氨酸0.6g,口服2次/d。治疗第14天患者肺弥散功能严重下降,重度低氧血症(SaO2曾降至50%以下);BUN18.90mmol/L,SCr286μmol/L,尿量200mL/d以下。入院第21天检查示BUN24.10mmol/L,SCr357μmol/L。患者血压明显下降伴频发心房颤动,终因多脏器衰竭和肺部感染死亡。

A 73-year-old man with atrial fibrilation received IV infusions of amiodarone 800 mg/d for one week,and then 600 mg/d for one month,400 mg/d for two months,and 200 mg/d for three months by mouth. After six months,the patient developed dry cough and shortness of breath. CT scan revealed pulmonary interstitial fibrosis in both lungs. Laboratory tests revealed the following levels and values：WBC 22.68×10^9/L,N 0.76; BUN 11.20 mmol/L,SCr 182 μmol/L; blood pH 7.36; PO2 35 mm Hg,PCO2 49 mm Hg and SaO2 64%. Amiodarone-related pulmonary interstitial fibrosis with infections was considered.The patient was given oxygen inhalation through a face mask,an IV infusion of levofloxacin 0.5 g once daily,an IV infusion of cefoperazone-sulbactam 3.0g twice daily,an IV infusion of methylprednisolone 40 mg twice daily,and acetylcysteine 0.6 g twice daily. On the day 14 of therapy,the man had a severe decrease in pulmonary diffusion capacity,severe hypoxemia （ SaO2 〈50%）,a BUN level of 18.90 mmol/L,a SCr level of 286 μmol/L,and a urine volume of 200 mL/d. On day 21 of hospitalization,his BUN was 24.10 mmol/L and his SCr was 357 μmol/L. The patient＇s blood pressure decreased markedly with frequent episodes of atrial fibrillation. Finally,the patient died of failure and pulmonary infections.