头孢哌酮舒巴坦钠致老年患者凝血功能异常

An elderly patient＇s dysfunction of blood coagulation due to cefoperazone sulbactam sodium

1例71岁女性急性肾衰竭合并急性左心衰竭患者因肺部感染静脉滴注头孢哌酮舒巴坦钠（头孢哌酮1000 mg＋舒巴坦500 mg入0.9％氯化钠注射液100 ml、1次/12 h）。用药前，患者活化部分凝血活酶时间（APTT）为43.7 s，凝血酶原时间（PT）14.8 s，INR 1.16，纤维蛋白原（FIB）5.86 g/L。用药第6天晨复查，APTT 84.3 s，PT 54.9 s，INR 6.00，FIB 3.38 g/L，考虑为头孢哌酮舒巴坦钠引起的凝血功能异常，停用该药，改用亚胺培南西司他丁，并静脉注射维生素K1。换药当日下午复查，APTT 42.6 s， PT 15.1 s，INR 1.19，FIB 3.55 g/L。停药第6天，APTT 34.9 s，PT 13.6 s，INR 1.05，FIB 3.56 g/L。

A 71-year-old woman with acute kidney injury complicated with acute left heart failure received IV infusion of cefoperazone sulbactam sodium（ cefoperazone 1000 mg plus sulbactam 500 mg dissolved in 0. 9% sodium chloride injection 100 ml,once per 12 hours）because of pulmonary infection. The laboratory tests before taking the medicine revealed the following results：activated partial thromboplastin time （APTT）43. 7 s,prothrombin time（PT）14. 8 s,international normalized ratio（INR）1. 16,fibrinogen （FIB）5. 86 g/L. The results of reexamining in the morning of day 6 of drug administration showed APTT 84. 3 s,PT 54. 9 s,INR 6. 00,FIB 3. 38 g/L. she was diagnosed as dysfunction of blood coagulation due to cefoperazone sulbactam sodium. Cefoperazone sulbactam sodium was stopped the same day,change with IV infusion of imipenem and cilastatin and intravenous injection of vitamin K1 . The results of reexamining in the afternoon of day of change medical prescription showed APTT 42. 6 s,PT 15. 1 s,INR 1. 19,FIB 3. 55 g/L. On day 6 of cefoperazone sulbactam sodium withdrawal,the results of reexamining showed APTT 34. 9 s,PT 13. 6 s,INR 1. 05,FIB 3. 56 g/L.