头孢哌酮/舒巴坦致老年患者凝血功能异常的相关因素分析

Analysis of relative factors for coagulation abnormalities induced by cefoperazone /sulbactam in elderly patients

目的分析头孢哌酮/舒巴坦导致老年患者凝血功能异常的相关因素。方法纳入因感染用头孢哌酮/舒巴坦治疗的老年患者(年龄≥65岁)74例,记录一般资料、用药情况、用药前的急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分)、肝肾功能、凝血功能,进行回归分析。观察出现凝血功能异常时头孢哌酮/舒巴坦的累积用药时间及停药或维生素K_1治疗前后凝血指标变化情况。结果凝血功能异常发生率为18.92%(14/74例)。APACHEⅡ评分与头孢哌酮/舒巴坦致老年患者凝血功能异常相关,比值比(OR)值为1.33(P<0.01)。APACHEⅡ评分预测凝血功能异常的受试者工作特征曲线(ROC曲线)下面积为0.86(P<0.01)。凝血功能异常组在停用头孢哌酮/舒巴坦的同时肌内注射维生素K_1,3 d后凝血功能指标明显改善(P<0.05)。结论 APACHEⅡ评分越高的老年患者应用头孢哌酮/舒巴坦治疗后发生凝血功能异常的风险越高,应加强监测。

Objective To investigate relative factors of coagulation abnormalities induced by cefoperazone/sulbactam in elderly patients. Methods Seventy - four elderly patients （ ≥65 years） with infection treated by cefoperazone/sulbactam were enrolled. The clinical data, medication prescribed, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）score, liver and kidney function parameters and coagulation function parameters were collected and analyzed by binary logistic regression analysis. The cumulative time of cefoperazone/sulbactam application when coagulation abnormalities emerged and the changes of coagulation function parameters before and after withdrawal cefoperazone/ sulbactam or with vitamin K1 treatment were observed. Results The incidence of coagulation abnormalities was 18.92% （14/74 cases ）. APACHEⅡ score showed a positive relationship with the coagulation abnor-malities induced by cefoperazone/sulbactam in elderly patients with odds ratio（OR） 1.33 （P 〈 0. 01 ）. Receiver operating characteristic （ ROC ） curve analysis showed that area under the curve （ AUC ） of APACHE Ⅱ score was 0. 86 （P 〈 0. 01 ）. The coagulation function parameters in abnormal coa- gulation group were improved significantly three days after the withdrawal of cefoperazone/sulbaetam or vitamin K1 treatment （P 〈 0. 05 ）.Conclusion The risk of coagulation abnormalities induced by cetoperazone/sulbactain is higher in elderly patients with a higher APACHE Ⅱ score. Coagulation function should be monitored.Conclusion The risk of coagulation abnormalities induced by cetoperazone/sulbactain is higher in elderly patients with a higher APACHE IT score. Coagulation function should be monitored.