125例替加环素不良反应回顾性分析

Retrospective Analysis of 125 Cases of Adverse Drug Reactions Induced by Tigecycline

目的通过分析替加环素不良反应发生规律,指导临床合理用药,警惕不良反应发生。方法回顾某三级综合医院2012—2018年临床应用替加环素的患者,分析患者用药后的症状及实验检查指标变化,提取125例不良反应,将病例信息进行归纳、分析。结果 125例患者中,原患疾病主要为肺部感染或合并皮肤软组织、腹腔、泌尿系统等感染,不良反应表现中诱发或加重凝血功能异常51例(41.8%)、肝功能损伤39例(31.2%)、恶心呕吐等胃肠道不适19例(15.2%)、皮疹、瘙痒16例(12.8%)。不良反应预后:消化系统及皮肤附件不良反应对症处理后均好转;肝功能损伤,在降酶、保肝等对症处理后仍不能好转。用药后出现凝血功能异常主要表现为凝血酶时间(TT)延长,国际标准化比值、D-二聚体、凝血酶原时间升高等,经输注血浆等处理,好转31例,未好转17例,3例死亡。结论临床使用替加环素应高度警惕凝血功能异常、肝功能损伤等不良反应发生,加强用药监测及合理用药指导,提高用药安全性。

Objective To pay more attention to the adverse drug reactions induced by tigecycline and provide references for rational use of drugs. Methods Patients receiving tigecycline in a level 3 general hospital during 2012-2018 were analyzed retrospectively to observe the change of symptom, sign and lab indexes after using tigecycline injection.125 cases of adverse reactions were extracted, and the case information was summarized and analyzed. Results The main diseases of 125 patients were lung infection or skin and soft tissue, abdominal cavity and urinary system infection.125 cases of ADR include 51 cases of inducing or aggravating blood coagulation abnormality（41.8%）, 39 cases of liver function injury（31.2%）, 19 cases of vomiting and other gastrointestinal discomfort（15.2%）,16 case of rash and pruritus（12.8%）. ADRs of digestive system were mild and recovered after symptomatic treatment as inhibiting acid, antiemetic.Severe ADR as liver function injury could not be recovered after symptomatic treatment as protecting liver, reducing enzyme. Coagulation function disorder was aggravated after medication, which mainly manifested as the prolongation of TT and the elevation of INR, D-dimer, PT, etc. After plasma infusion treatment, 31 cases improved, 17 cases did not improve, and 3 cases died. Conclusion Great importance should be attached to severe ADR as coagulation function disorder, liver function injury when using tigecycline, in order to ensure the safety of drug use.