多黏菌素B致横纹肌溶解1例

Rhabdomyolysis induced by polymyxin B:one case report

1例85岁男性升结肠癌患者于全麻下行腹腔镜辅助下右半结肠根治性切除术后术后第20天出现泛耐药鲍曼不动杆菌引起的肺部感染,予多黏菌素B 50万U qid联合替加环素50 mg q12h抗感染治疗。多黏菌素B用药后,患者血清肌酸磷酸激酶(creatine kinase,CK)进行性升高,用药后最高升至5804 U·L^(–1),考虑为多黏菌素B所致横纹肌溶解(rhabdomyolysis,RM)。另外,用药7 d后测多黏菌素B稳态血药浓度为2.1 mg·L^(-1)。停用多黏菌素B后,血清肌酸磷酸激酶呈下降趋势并恢复至正常水平。该不良反应无剂量依赖性,为新的罕见的B类不良反应,对罕见不良反应的认识有助于确保多黏菌素B治疗的临床安全性。

An 85-year-old male of ascending colonic cancer developed pulmonary infection caused by Pan drug resistant Acinetobacter baumannii on the 20th day after laparoscopic assisted radical resection of right colon under general anesthesia.Polymyxin B 500000 U qid was prescribed along with tigecycline 50 mg q12h for anti-infection.After dosing of polymyxin B,serum level of creatine kinase(CK)spiked progressively and peaked at 5804 U·L^(-1).It was probably rhabdomyolysis(RM)caused by polymyxin B.After 7-day treatment,a steady-state plasma concentration of polymyxin B was attained at 2.1 mg·L^(-1).After a discontinuation of polymyxin B,serum creatine phosphokinase showed a downward trend and normalized.This dose-independent adverse reaction was a new rare class B adverse reaction.A better understanding of rare adverse reactions helps to ensure the clinical safety of polymyxin B dosing.