左氧氟沙星致过敏性休克诱发横纹肌溶解症

Levofloxacin-induced anaphylactic shock and rhabdomyolysis

1例42岁男性患者因醉酒后摔伤,伤口污染严重,给予盐酸左氧氟沙星注射液0.2 g溶于0.9%氯化钠注射液250 ml静脉滴注预防感染。首次静脉滴注左氧氟沙星约2 min(注入药液约4 ml)时,患者出现呼吸困难,烦躁不安,心率120次/min,呼吸26次/min,血压测不到,血氧饱和度0.80。立即停用左氧氟沙星并给予肾上腺素和地塞米松抗过敏治疗。2 min后,患者心率降至50次/min,呼吸减弱至8次/min,皮肤紫绀。诊断为过敏性休克,Ⅱ型呼吸衰竭。立即行心肺复苏,气管插管,气囊辅助通气,去甲肾上腺素抗休克。3 h后,患者出现茶色尿,肌酸激酶、肌红蛋白、丙氨酸转氨酶、天冬氨酸转氨酶和血清肌酐升高;肌酸激酶峰值达17160 U/L,肌红蛋白>3000μg/L,血清肌酐峰值达492μmol/L,考虑横纹肌溶解症合并急性肾损伤。给予血液滤过、血浆输注、纠正酸中毒及补液等对症支持治疗。10 h后,患者血压恢复正常,继续给予呼吸机辅助呼吸,病情逐渐好转。34 d后,患者肌红蛋白、肌酸激酶、肌酐均恢复至正常值。38 d后,患者恢复自主呼吸,撤离呼吸机。

A 42-year-old male patient,who suffered serious wound pollution due to falling after drinking,received an intravenous infusion of levofloxacin hydrochloride injection 0.2 g dissolved in 0.9%sodium chloride injection 250 ml to prevent infection.When the first dose of levofloxacin was infused intravenously for about 2 minutes(about 4 ml),the patient suddenly developed dyspnea,restlessness,and agitation.His heart rate was 120 beats per minute,breath rate was 26 times per minute,blood pressure was undetectable,and blood oxygen saturation was 0.80.Levofloxacin was immediately discontinued and antiallergic therapy such as epinephrine and dexamethasone was given.Two minutes later,the patient′s heart rate dropped to 50 beats per minute,breathing decreased to 8 times per minute,and cyanotic appeared on the skin.Anaphylactic shock and type 2 respiratory failure were diagnosed and cardiopulmonary resuscitation,tracheal intubation,balloon assisted ventilation,and norepinephrine etc.were given immediately.Three hours later,the patient developed dark urine and elevated creatine kinase(CK),myoglobin,alanine aminotransferase,aspartate aminotransferase,and serum creatinine(Scr).His peak value of CK was 17160 U/L,myoglobin was>3000μg/L,and peak value of Scr was 492μmol/L.Rhabdomyolysis with acute kidney injury was considered.The symptomatic and supportive treatments such as hemofiltration,plasma infusion,correction of acidosis,and fluid replacement were given.Ten hours later,the patient′s blood pressure returned to normal,ventilator assisted breathing was continued,and the patient′s condition was gradually improved.Thirty-four days later,the levels of myoglobin,CK and Scr returned to within the normal range.Thirty-eight days later,the patient returned to spontaneous breathing and the ventilator was withdrawn.