6例万古霉素致药物热病例报道及分析

Analysis of Clinical Characteristics of Drug-Induced Fever Caused by Vancomycin

目的探讨万古霉素致药物热的临床特点,为临床诊断药物热及合理用药提供参考。方法对广西壮族自治区人民医院2017年1月—2021年12月使用万古霉素进行治疗的病例进行筛选,筛选发生万古霉素相关药物热的患者。收集患者的性别、年龄、原患疾病、用药情况、万古霉素血药谷浓度、体温峰值等资料进行汇总分析。结果1976例患者中有6例出现药物热,发生率为0.3%。6例患者体温峰值38.8~41.0℃,平均(39.80±0.76)℃;药物热发生在用药第4~10天,平均(7.2±2.9)d,中位数为7.5 d。停药后所有病例的体温均在1~7 d恢复正常,平均(4.2±1.9)d,中位数为1.5 d。4例伴有1个以上系统或器官的损害,主要临床表现为血细胞减少、皮疹和肾功能损害,停药后均可恢复。5例患者血药浓度>20 mg/L,1例患者观察到与血药浓度相关的体温变化。结论万古霉素药物热的发生不易诊断,用药时应该提高警惕。做好血药谷浓度监测,可有效提高用药安全性,且可减少药物热的发生。

Objective To explore the clinical characteristics of drug fever caused by vancomycin,so as to provide reference for clinical diagnosis of drug fever and rational drug use.Methods Screened the cases treated with vancomycin in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2017 to December 2021,and patients with vancomycin related drug fever were screened out.The data of gender,age,primary disease,drug use,vancomycin blood valley concentration,peak body temperature and other data of these patients were collected and analyzed.Results A total of 6 patients occurred drug fever in 1976 patients,with an incidence of 0.3%.The peak temperature of these 6 patients was 38.8-41.0℃,with an average of(39.80±0.76)℃.Drug fever occurred on the 4th to 10th day of treatment,with an average of(7.2±2.9)d and a median of 7.5 days.After drug withdrawal,the body temperature of all cases returned to normal within 1-7 days,with an average of(4.2±1.9)d and a median of 1.5.4 cases were accompanied by damage to more than one system or organ.The main clinical manifestations were hemopenia,rash and renal function damage,which could be recovered after drug withdrawal;among them,the blood concentration of 5 patients was more than 20 mg/L,body temperature changes related to blood drug concentration were observed in 1 case.Conclusion The occurrence of vancomycin drug fever is not easy to diagnose,so we should be vigilant when taking drugs,and conduct blood drug concentration monitoring,which can effectively improve the safety of medication and may reduce the occurrence of drug fever.