静脉滴注乳酸左氧氟沙星诱发尖端扭转型室性心动过速

Torsades de pointes after receiving an intravenous infusion of levofloxacin lactate

1例87岁女性患者因社区获得性肺炎,给予乳酸左氧氟沙星（300 mg/100 ml）和维生素C（1.0 g）静脉滴注.14 h后再次静脉滴注乳酸左氧氟沙星约40 min时,患者出现寒战、气促、呕吐,立即停止输注药物.随后出现呼吸和心跳停止.心肺复苏约1 min后患者呼吸和心跳恢复,心电图示心房纤维颤动,心率150次/min.静脉泵入硝酸甘油约30 min,患者突然意识不清、室性心动过速,电复律后恢复窦性心律,15 min后心电图示尖端扭转型室性心动过速,心率校正后QT间期为557 ms.停用硝酸甘油并给予胺碘酮治疗,未再出现尖端扭转室性心动过速.次日晚,心电监护频繁示尖端扭转型室性心动过速,立即给予胺碘酮治疗,约50 s恢复窦性心率.其后患者未再发生尖端扭转型室性心动过速.

A 87-year-old female patient received an intravenous infusion of levofloxacin lactate （300 mg/100 ml） and vitamin C 1.0 g for community-acquired pneumonia.Fourteen hours later,about 40 minutes after the second levofloxacin lactate infusion start,the patient presented with chill,shortness of breath,and vomiting and the infusion was stopped immediately.And then she developed respiratory and cardiac arrest.After 1 minute of cardiopulmonary resuscitation,she returned to normal breath and heartbeat and experienced atrial fibrillation with a heart rate of 150 beats/min.About 30 minutes of nitroglycerin infusion via pump start,the patient developed suddenly unconsciousness and ventricular tachycardia and returned to sinus rhythm after undergoing electroversion.Fifteen minutes later,the electrocardiogram showed torsades de pointes with a heart rate-adjusted QT interval of 557 ms.Nitroglycerin was withdrawn and amiodarone was given.Torsades de pointes did not recur.At the next night,her electrocardiograph monitoring revealed frequent torsades de pointes.Amiodarone was given immediately and,about 15 seconds later,she returned to sinus rhythm.Hereafter,the patient did not developed torsades de pointes again.