术中快速静脉滴注万古霉素致严重低血压的文献分析并实例探讨

Literature review and case analysis of severe hypotension induced by intraoperative rapid intravenous infusion of vancomycin

目的:探讨术中快速静脉滴注万古霉素致严重低血压的临床特点及防治措施。方法:对文献检索和我院上报的术中快速静脉输注万古霉素致严重低血压案例进行分析,包括万古霉素输注速度、低血压发生时间、合并症状及转归等情况。结果:共收集14例,男性8例,女性6例;万古霉素用药剂量为50~1000 mg;输注速度16.7~500.0 mg·min^-1;发生低血压最短1 min,最长30 min,中位时间5(1,10)min;低血压发生时收缩压的中位值50(38,69)mm Hg,舒张压的中位值22(15,34)mm Hg,其中10例患者有药物过敏史,5例患者合并皮肤潮红或红疹的特征,5例患者有心率加快的描述。结论:术中快速静脉输注万古霉素可能发生低血压,发病迅速且症状严重,需及时采取升压措施及抗组胺药物治疗,预后较好。

Objective:To analyze the severe hypotension cases induced by rapid intravenous infusion of vancomycin in literature and our hospital,and explore its clinical characteristics and the methods of prevention and treatment.Methods:The cases collected were analyzed in respect of vancomycin infusion rate,occurrence time of adverse reactions,combined symptoms,outcomes and so on.Results:There were 14 cases in the literature and our hospital,including 8 males and 6 females.The dosages of vancomycin were 50–1000 mg.The infusion rates of vancomycin were 16.7–500.0 mg·min^-1.The onset of hypotension was as short as 1 minute,as long as 30 minutes,and the median time was 5(1,10)minutes.The median systolic blood pressure at the time of hypotension was 50(38,69)mm Hg,and the median diastolic blood pressure was 22(15,34)mm Hg.Among all cases,10 cases of them had the history of drug allergy,5 patients had the complication of skin flushing or rash,and 5 patients had an increased heart rate.Conclusion:Intraoperative rapid intravenous infusion of vancomycin may cause hypotension,which is characterized by rapid onset and severe symptoms.Therefore,it is necessary to raise blood pressure and take antihistamine treatment in time.The prognosis is good.