头孢孟多致多器官功能衰竭

Cefamandole-induced multiple organ failure

1例73岁女性患者因结肠镜息肉切除术后预防感染，静脉滴注头孢孟多2．0g。输注完毕约2h，患者出现剧烈腹痛，给予解痉治疗未缓解；40min后出现血白细胞减少（1．0×109／L），予丙帕他莫止痛，疼痛缓解。次日11：00患者突然出现血压降低[最低至80／50mmHg（1mmHg=0．133kPa）]、心率加快，立即给予升压和补充血容量治疗。12：30再次静脉滴注头孢孟多2．0g，输注完毕后，患者出现休克，血压70／30mmHg，并逐渐出现急性肾损伤、急性肺水肿，左心功能减低、肝损伤、血细胞减少、凝血功能障碍和弥散性血管内凝血。转入重症监护病房，经2周抢救治疗，患者病情逐渐好转。2个月后，除。肾功能异常（血清肌酐165I．μmol／L，尿素9．1mmol／L）外，肝功能、凝血功能及血细胞等各项指标均恢复正常。

A 72-year-old woman received an IV infusion of cefamandole 2. 0 g for preventing infection after eolonoscopie polypectomy. Two hours after infusion completion, the patient presented with severe abdominal pain and the symptom did not relieve after spasmolysis. At the next 11 ： 0（3 am, she suddenly developed hypotension （the minimum level of 80/50 mm Hg） and elevated heart rate. Treatments for raising blood pressure and supplying blood volume were given immediately. At 12：30 am, an IV infusion of cefamandole 2.0 g was given again and, after infusion completion, she developed shock and a low blood pressure of 70/30 mm Hg. And she experienced gradually acute kidney injury, acute pulmonary edema, left heart dysfunction, liver damage, hypocytosis, coagulation disorders, and disseminated intravascular coagulation. The patient was admitted to intensive care unit and, after two-week resuscitation, her condition improved. Two months later, her hepatic function, coagulation function, and blood ceils returned to normal except abnormal renal function （ a serum creatinine level of 165 ttmol/L and a urea nitrogen level of 9. 1 mmol/L ）.