亚胺培南西司他丁钠致严重血小板减少

Severe thrombocytopenia induced by imipenem and cilastatin sodium

1例76岁男性不稳定型心绞痛患者因肺炎使用阿莫西林克拉维酸钾联合左氧氟沙星治疗无效,换用亚胺培南西司他丁钠1.0 g静脉滴注、1次/8 h。用药前患者血小板计数(PLT)109×109/L。用药9 d后,患者咳嗽、喘憋症状好转,体温恢复正常,但出现皮肤瘀点,伴有少量鼻出血和血尿,复查PLT为0。立即停用亚胺培南西司他丁钠,给予重组人血小板生成素联合甲泼尼龙和人免疫球蛋白治疗,血小板逐渐升高,出血症状消失。10 d后复查,PLT 173×109/L。本例提示老年患者应慎用大剂量亚胺培南西司他丁钠,并在治疗期间加强监测。

A 76-year-old male patient with unstable angina pectoris switched to an Ⅳ infusion of imipenem and cilastatin sodium 1.0 g once every 8 hours because of the ineffective treatment of pneunionia with amoxicillin and clavulanate potassium combined with levofloxacin.The platelet count(PLT)was 109×10/L before treatment.After 9 days of medication,the patient's symptoms of cough and dyspnea were improved,his body temperature returned to normal,but he developed skin petechiae,accompanied by a small amount of epistaxis and hematuria.At the same time,his PLT was 0.1 mipenem and cilastatin sodium was immediately discontinued,recombinant human thrombopoietin combined with methylpredniso・lone and human immunoglobulin were given,the patient's PLT gradually increased and the bleeding symptoms disappeared.Ten days later,his PLT was 173×1O9/L.It is suggested that high-dose imipenem and cilastatin sodium should be used cautiously in elderly patients and the monitoring should be strengthened during the treatment.