酮咯酸氨丁三醇注射液致消化性溃疡并出血性休克

Peptic ulcer and hemorrhagic shock induced by ketorolac tromethamine injection

1例73岁男性患者因痛风性关节炎给予酮咯酸氨丁三醇注射液60 mg入0.9%氯化钠注射液250 ml静脉滴注、1次/d。第3次给药约一半时患者出现腹部隐痛,但未予重视。之后又出现呕吐(呕吐物带血)、黑便,伴上腹不适。考虑与使用酮咯酸氨丁三醇注射液有关,停药观察。患者症状持续并加重,出现心慌、头晕、乏力、呕血、解鲜血便、晕厥等。血压58/33 mmHg(1 mmHg=0.133 kPa),血红蛋白92 g/L。胃镜及病理检查提示胃窦、胃角多发溃疡,慢性浅表性-糜烂性胃炎,十二指肠球炎,幽门螺杆菌(+)。诊断为消化性溃疡、出血性休克,给予去甲肾上腺素、生长抑素、艾司奥美拉唑及营养支持治疗,2周后患者逐渐痊愈,粪潜血阴性。

A 73‑year‑old male patient was given intravenous infusion of ketorolac tromethamine injection 60 mg diluted in 0.9%sodium chloride injection 250 ml once daily for gouty arthritis.At about half of the third infusion,he developed dull pain in the stomach,but did not pay much attention to it.Then vomiting(with blood in the vomitus)and melena accompanied by epigastric discomfort occurred later.The symptoms were considered to be related to ketorolac tromethamine injection,the drug was stopped,and the patient′s condition was observed.But the above symptoms continued and worsened,and palpitation,dizziness,fatigue,hematemesis,fresh blood on defecation,syncope,etc.occurred.The patient′s blood pressure was 58/33 mmHg and hemoglobin was 92 g/L.Gastroscopy and pathological examination showed multiple ulcers in antrum and the angle of the stomach,chronic superficial and erosive gastritis,duodenal bulbar inflammation,and Helicobacter pylori(+).The patients were diagnosed with peptic ulcer and hemorrhagic shock.Norepinephrine,somatostatin,esomeprazole,and nutritional and supportive treatments were given,and 2 weeks later,the patient gradually recovered and the fecal occult blood was negative.