1例左氧氟沙星氯化钠注射液致尖端扭转型室性心动过速的用药分析与药学监护

Medication analysis and pharmaceutical care on a case of torsade de pointes caused by levofloxacin and sodium chloride injection

1例82岁男性患者,入院诊断为"冠心病、严重心力衰竭合并双肺感染4个月余",入院后先后给予哌拉西林舒巴坦钠(2.5 g,q 12 h,ivgtt)、头孢哌酮钠舒巴坦钠(3 g,q 12 h,ivgtt)抗感染治疗,疗效欠佳。后咳嗽咳痰加重,痰培养结果为嗜麦芽窄食单胞菌,全院会诊建议选用左氧氟沙星(0.5 g,q 24 h,ivgtt),临床药师考虑到患者具有多个QT间期延长的危险因素建议谨慎选用对QT间期有影响的药物,应严密监测患者的QTc变化,并根据肾功能调整药物剂量(0.5 g,q 48 h,ivgtt)。治疗9 d后患者发生尖端扭转型室性心动过速(TdP)。临床药师给予患者全程药学监护,协助医师及时确定导致TdP的药物,停用左氧氟沙星氯化钠注射液并补充血钾防治严重心律失常复发,停药4 d后患者QT间期逐渐恢复至正常值,病情控制平稳,未再出现新的严重心律失常。

One 82-year-old male patient was admitted into hospital and diagnosed as coronary heart disease,severe heart failure and pneumonia.After admission,piperacillin sodium and sulbactam sodium(2.5 g,q 12 h,ivgtt),cefoperazone sodium and sulbactam sodium(3 g,q 12 h,ivgtt)were successively given to the patient but had poor effect.Cough and expectoration aggravated and the result of sputum culture showed Stenotrophomonas maltophilia.Levofloxacin(0.5 g,q 24 h,ivgtt)was recommended according to the hospital consultation.Considering that the patient had several risk factors of QT interval prolongation,clinical pharmacists suggested that drugs associated with QT interval prolongation should be carefully selected,changes of QTc should be monitored during the treatment,and the dose of levofloxacin should be adjusted to 0.5 g,q 48 h according to the renal function of the patient.The patient developed torsades de pointes(TdP)9 days later.Clinical pharmacist carried out the whole range of pharmaceutical care on the patient by helping physicians determine the drug causing TdP in time,stop levofloxacin and supply blood potassium to prevent the recurrence of serious arrhythmia.The QT interval of patient gradually returned to normal range 4 days later.The patient's condition was stable and no new serious arrhythmia appeared again.