头孢噻肟钠致急性心肌损伤和急性心力衰竭

Acute myocardial injury and acute heart failure induced by cefotaxime sodium

1例30岁女性患者因牙痛静脉滴注头孢噻肟钠1.0 g，滴注约20 min后，患者突然出现胸闷、心慌、四肢抖动。立即停止滴注药物并静脉注射地塞米松5 mg无缓解，遂急诊入院。入院心电图检查示急性心肌缺血，实验室检查示肌钙蛋白T（TnT）0.033 ng/ml，肌酸激酶（CK）175 U/L，肌酸激酶同工酶（CK-MB） 2.95 μg/L，乳酸脱氢酶802 U/L。入院后约0.5 h患者出现喘憋并咳粉红色泡沫样痰，以无创呼吸机辅助呼吸，给予吗啡、托拉塞米、多巴胺、硝酸甘油、二羟丙茶碱等对症治疗；后约4.5 h后患者症状明显缓解；约7 h复查示TnT 0.551 μg/L，CK-MB 15.43 μg/L，肌红蛋白149 μg/L；5 d后患者心电图恢复正常；1周后肌钙蛋白、CK-MB和肌红蛋白恢复正常。

A 30-year-old female patient received an IV infusion of cefotaxime sodium 1.0 g for toothache. About 20 minutes later, the patient developed chest tightness, palpitation, and limbs shaking. The drug was immediately stopped and an IV injection of dexamethasone was given. However, the symptoms were not improved and the patient was presented to emergency department in our hospital. On admission, electrocardiogram revealed acute myocardial ischemia, troponin T （TnT） 0.033 μg/L, creatine kinase （CK） 175 U/L, creatine kinase isoenzyme MB （CK-MB） 2.95 μg/L. About 0.5 hour of admission, the patient developed asthmatic symptoms and coughed up pink frothy sputum. Ventilator support, morphine, torasemide, dopamine, nitroglycerin, and diprophylline were given. About 4.5 hours of admission, her symptoms were improved. About 7 hours of admission, TnT was 0.551 μg/L, CK-MB 2.95 μg/L, myohemoglobin 149 μg/L. Five days of admission, ECG returned to normal and 1 week later, TnT, CK-MB and myohemoglobin levels returned to normal.