单用头孢哌酮钠舒巴坦钠致凝血功能异常的临床分析及对策

Clinical analysis and countermeasures of cefoperazone sodium and sulbactam sodium- induced coagulation abnormalities

目的 回顾性分析单用头孢哌酮钠舒巴坦钠致凝血功能异常的临床资料,观察应用维生素K1治疗后凝血指标的变化。方法 选取2013年1月至2014年12月入住北京同仁医院急诊病房的经头孢哌酮钠舒巴坦钠治疗肺部感染后出现凝血功能异常的52例老年患者,分别记录患者入院当天血常规、肝肾功能和凝血功能指标,主要包括血浆凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）,出现凝血功能异常时使用头孢哌酮钠舒巴坦钠的剂量和累积时间,以及应用维生素K1后凝血功能转为正常时间。观察维生素K1治疗前后凝血指标变化情况。结果 52例患者中40例患者头孢哌酮钠舒巴坦钠用量9 g/d,12例根据肌酐清除率调整头孢哌酮钠舒巴坦钠用量6 g/d。患者应用头孢哌酮钠舒巴坦钠后发现凝血异常时间波动在3~8 d,应用维生素K1后凝血功能转为正常时间波动在3~12 d。52例患者中表现为皮肤淤点、淤斑19例（36.5%）,消化道出血和大便潜血阳性8例（15.4%）,尿路出血6例（11.5%）,牙龈出血3例（5.8%）,其余16例（30.8%）未见明显出血征象。与维生素K1治疗前比较,治疗后PT和APTT有明显改善,差异有统计学意义（P〈0.05）。结论 单用头孢哌酮钠舒巴坦钠治疗老年患者肺部感染可引起亚临床维生素K缺乏,表现为临床出血征象和化验凝血指标异常,而出现异常后尽早使用维生素K1则可使凝血功能明显改善。

Objective To retrospective analyze the clinical data of coagulation abnormalities induced by cefoperazone sodium and sulbactam sodium,and observe changes in coagulation parameters after treatment with vitamin K1. Methods 52 patients with coagulation abnormalities due to sodium cefoperazone sodium and sulbactam sodium treatment for pulmonary infection were collected from emergency ward of Beijing Tongren Hospital during January 2013 to December 2014. Routine blood tests,liver and kidney function parameters,coagulation function parameters on admission were recorded,including prothrombin time（ PT） and activated partial thromboplastin time（ APTT）. The dosage and cumulative time of cefoperazone sodium and sulbactam sodium application were recorded when coagulation abnormalities emerged. The time when coagulation function converted to normal after the application of vitamin K1 are also recorded. To observe the changes of coagulation vitamin K1 before and after treatment. The changes of coagulation parameters treatment were observed before and after vitamin K1. Results In the 52 cases,40 patients＇ cefoperazone sodium and sulbactam sodium dosage were 9 gram a day,other 12 patients＇ dosage were 6 gram a day adjusted according creatinine clearance rate. Presentation time of coagulation abnormalities were in 3 ~ 8 days after the application of cefoperazone sodium and sulbactam sodium. After treatment with vitamin K1,coagulation function converted to normal in 3 ~ 12 days. In 52 patients,symptoms were noted in 19 cases（ 36. 5%）for skin petechiae or ecchymosis,in 8 cases（ 15. 4%） for gastrointestinal hemorrhage and fecal occult blood positive,in 6 cases（ 11. 5%） for urinary tract hemorrhage,in 3 cases（ 5. 8%） for gingival bleeding,and the remaining 16 patients（ 30. 8%） showed no signs of bleeding. Compared with the previous treatment of vitamin K1,PT and APTT had improved significantly after that. The difference was statistically significant（P 0. 05）. Conclusion Using cefoperazone sodium and sulbactam sodium alone for pulmonary infections in elderly patients can cause subclinical vitamin K deficiency,showing clinical signs of bleeding and laboratory coagulation abnormalities. Using vitamin K1 as soon as possible after abnormal occurs can make coagulation function be significantly improved.