利奈唑胺诱导致命性乳酸中毒:一种极易混淆为脓毒性休克的不良反应

Linezolid-induced fatal lactic acidosiss:an adverse reaction easily confu-sed with septic shock

回顾性分析北京、山东两所医院诊治的3例利奈唑胺诱导乳酸中毒患者的临床资料,并检索国内外相关文献,探讨其致病机制、危险因素、临床表现和治疗方案。3例患者因病情使用利奈唑胺抗感染治疗,在用药的不同阶段出现难以用脓毒性休克解释的乳酸中毒,停用利奈唑胺并给予床旁连续性静脉-静脉血液滤过治疗后,患者血乳酸水平明显下降,最终临床诊断为利奈唑胺诱导的乳酸中毒,但初诊医生均考虑为脓毒性休克。经积极治疗,2例患者转归良好,1例患者死亡。利奈唑胺诱导的乳酸中毒易被误诊为脓毒性休克,广大临床医生应提高对此不良反应早期诊断的认知与识别,采取有效的治疗措施,以改善患者预后。

Clinical data of 3 patients with linezolid-induced lactic acidosis treated in 2 hospitals in Beijing and Shandong were retrospectively analyzed,and relevant literatures at home and abroad were retrieved.The pathogenesis,risk factors,clinical manifestations,and treatment scheme were valuated.Three patients received linezolid anti-infection treatment due to their disease condition.At different phases of treatment,they developed lactic acidosis that was difficult to be explained with septic shock.After discontinuing linezolid and receiving bedside continuous veno-venous hemofiltration(CVVH)treatment,patient’s blood lactate levels decreased significantly.It is clinically diagnosed linezolid-induced lactic acidosis finally,but the initial diagnosis was septic shock by all doctors.After active treatment,2 patients recovered and 1 patient died.Linezolid-induced lactic acidosis is easily to be misdiagnosed as septic shock.Clinicians should enhance their understanding and recognition of the early diagnosis of the adverse reactions,take effective measures,so as to improve patient prognosis.