一例心衰患者使用头孢曲松导致严重肝功能异常的用药分析与药学监护

Medication analysis and pharmaceutical care of a patient with heart failure with severe liver dysfunction caused by ceftriaxone

1例68岁男性患者,既往有多次心衰发作住院病史,本次因“肺部感染、心力衰竭”入住急诊,给予心衰常规治疗及头孢曲松抗感染治疗,用药前肝功能正常(ALT 35 U/L),用药4 d后肝酶轻度升高(ALT 84 U/L),感染症状和心衰症状明显缓解,故出院,出院后未使用抗感染药物。出院第4天患者再次因心衰及肺部感染复发入住心脏监护室,延续出院前药物治疗方案,患者心衰症状和感染症状明显缓解,但肝功能出现严重异常(ALT 1078 U/L,符合严重肝功能损害的诊断标准)。临床药师详细评估患者治疗方案和用药前后肝功能变化、感染及心衰控制情况,并查阅相关文献,认为患者肝功能异常与头孢曲松相关,建议停头孢曲松,医生接受建议停用头孢曲松;临床药师持续监护患者病情变化及转氨酶转归,停用头孢曲松19 d后肝功能恢复正常。

A 68-year old male patient with a history of multiple heart failure attacks was admitted to the emergency department because of“pulmonary infection and heart failure”.The patient was given conventional heart failure treatment plus ceftriaxone anti-infective treatment.The liver function was normal before treatment(ALT 35 U/L).After 4 days of treatment,the liver enzyme was slightly increased(ALT 84 U/L);however,the symptoms of infection and heart failure were significantly relieved and the patient was discharged without anti-infective drugs.On the fourth day after discharge,the patient was again admitted to the cardiac intensive care unit due to recurrence of heart failure and pulmonary infection,and the pre-discharge medication regimen was continued.The symptoms of heart failure and infection were significantly relieved,but the liver function was seriously abnormal(ALT 1078 U/L,reaching the diagnostic standard of severe liver function damage).Clinical pharmacists evaluated the treatment plan,liver function changes before and after medication,infection and heart failure control,and reviewed relevant literatures,considering that the abnormal liver function of patients was related to ceftriaxone,and recommended to stop using ceftriaxone.Doctors accepted the suggestion and stopped using ceftriaxone.After drug withdrawal,clinical pharmacists continuously monitored the condition and transaminase of the patient,and the liver function returned to normal after 19 d.