1例左氧氟沙星导致QT间期延长的案例分析

A case analysis of QT interval prolongation caused by levofloxacin

1例87岁男性患者,既往食管癌放疗术后,主因咳嗽、咳痰20 d入院。入院后诊断为"肺部感染"。初始治疗给予头孢曲松(2 g,qd,ivgtt)抗感染治疗8 d,复查CT示双肺病变较前加重,6月8日升级抗感染方案为"亚胺培南西司他丁(0.5 g,q 8 h,ivgtt)+左氧氟沙星(0.5 g,qd,ivgtt)"静脉滴注,6月12日心电图示QTc 472 ms,6月15日QTc 475 ms,考虑为左氧氟沙星引起的不良反应,6月18日停用左氧氟沙星。6月20日QTc间期恢复正常(392 ms)。6月21日,患者感染指标好转,抗感染方案再次降级为"头孢哌酮舒巴坦(3 g,q 12 h,ivgtt)+左氧氟沙星(0.5 g,qd,ivgtt)",3 d后心电图示QTc 500 ms,明显延长,立即停用左氧氟沙星,6月27日监测心电图,QTc仍为499 ms,尚未恢复正常,6月28日患者出院,未再监测心电图。

One87-year-old male patient who had undergone the postoperative esophageal cancer radiotherapy washospitalized because of cough and expectoration for20days.The patient was diagnosed as pulmonary infection and treated withceftriaxone(2g,qd,ivgtt)after admission.Eight days later,the lesion of bilateral lung showed by CT examination was aggravated.Then ceftriaxone was changed to imipenem/cilastatin(0.5g,q8h,ivgtt)and levofloxacin(0.5g,qd,ivgtt)on June8.Duringthe treatment,the QTc interval was472ms showed by electrocardiogram on June12and475ms on June15.The QTc intervalprolongation was considered as the adverse reactions of levofloxacin.So the levofloxacin was stopped on June18.In the meantime,the QTc interval returned to normal(392ms)on June20.The patient's infective indicators improved on June21,and the imipenem/cilastatin was changed to cefoperazone/sulbactam(3g,q12h,ivgtt)and levofloxacin(0.5g,qd,ivgtt),then the QTc intervalextended to500ms three days later.The levofloxacin was stopped in time.The QTc interval was still499ms which did not return tonormal on June27.And the next day,the patient was discharged and the electrocardiogram was no further monitored.