硫酸多粘菌素B致患者肢体麻木活动受限

One case of limb numbness and limitation of activity caused by polymyxin B sulphate

1例18岁女性患者,因咳嗽、咳痰2年余,加重20 d入院,诊断为支气管扩张,肺部感染,给予美罗培南(1.0 g,bid,ivgtt),莫西沙星(0.4g,qd,ivgtt),伏立康唑(0.2g,bid,ivgtt)治疗,6d后患者症状未好转,根据药敏结果停用美罗培南、伏立康唑,调整为注射用硫酸多粘菌素B(50万单位+0.9%氯化钠注射液100 m L,bid,ivgtt)抗感染治疗,在给药过程中患者出现四肢麻木、肢体活动受限,伴随全身瘙痒,立即停用注射用硫酸多粘菌素B,给予地塞米松注射液(5 mg+0.9%氯化钠注射液20 m L,iv),维生素C注射剂(1 g+5%葡萄糖注射液250 m L,ivgtt),葡萄糖酸钙注射液(1 g+5%葡萄糖注射液250 m L,ivgtt),患者全身麻木、瘙痒减轻,肢体活动受限症状有所缓解。次日增大溶媒剂量继续应用注射用硫酸多粘菌素B(50万单位+0.9%氯化钠注射液250 m L,bid,ivgtt),患者再次出现轻微麻木瘙痒症状,肢体活动未受限,考虑患者出现不良反应是由注射用硫酸多粘菌素B所致,且严重程度与溶解药物的浓度有关。

One 18-year-old female patient was admitted to hospital due to cough and expectoration for more than 2 years,aggravation for 20 days.She was diagnosed as bronchiectasis and pulmonary infection.Meropenem(1.0 g,bid,ivgtt),moxifloxacin(0.4 g,qd,ivgtt)and voriconazole(0.2 g,bid,ivgtt)were given to her.After 6 days,her symptoms did not improve.According to the results of drug sensitivity test,meropenem and voriconazole were replaced by polymyxin B sulphate for injection(500000 units+0.9%sodium chloride injection 100 mL,bid,ivgtt).During the course of administration,she developed numbness of limbs and limitation of activity accompanied with itch all over the body.Polymyxin B sulphate for injection was stopped immediately and dexamethasone(5 mg+0.9%sodium chloride injection 20 mL,iv),vitamin C injection(1 g+5%glucose injection 250 mL,ivgtt),calcium gluconate injection(1 g+5%glucose injection 250 mL,ivgtt)were given to her.The above symptoms were relieved.The next day,polymyxin B sulphate for injection with more solvent(500000 units+0.9%sodium chloride injection 250 mL,bid,ivgtt)was given to her.She developed limb numbness and itch again without limitation of activity,which indicated that her symptoms was the adverse drug reaction(ADR)caused by polymyxin B sulphate for injection,and the severity of this ADR was related to the concentration of polymyxin B sulphate for injection.