摘要
1例80岁男性高血压病、动脉粥样硬化、风湿性心脏病、心房颤动患者长期口服华法林钠（3 mg，1次/d），国际标准化比值（INR）维持在2.00～3.00。因肺部感染伴发热加用哌拉西林钠他唑巴坦钠（4.5 g，1次/8 h）静脉滴注、复方氨林巴比妥（2 ml）肌内注射、洛索洛芬钠（30 mg）口服等。加药前凝血酶原时间（PT） 27 s，INR 2.45。2 d后，患者出现痰中带血。次日停用华法林钠。停用华法林钠第2天，患者突发左上腹剧烈胀痛并可触及包块，触痛明显，当日PT 42 s，INR 4.46。次日腹部超声检查示左侧腹直肌内有4.5 cm×2.7 cm×1.5 cm囊性结构，腹部CT检查见左侧腹直肌内圆形高密度影，考虑左侧腹直肌内血肿可能性大。立即给予维生素K1 10 mg，1次/d肌内注射，停用哌拉西林钠他唑巴坦钠，换为头孢他啶。2 d后，患者腹痛基本消失，PT 16 s，INR 1.11。1周后恢复口服华法林钠（起始量2.25 mg，1次/d），并根据INR调整剂量。1个月后腹部超声复查示血肿明显减小（3.5 cm×0.8 cm）。
An 80-year-old male patient with hypertension, arteriosclerosis, rheumatic heart disease, and atrial fibrillation long-term daily oral warfarin sodium 3 mg once daily. International normalized ratio （INR） was maintained at 2.00 to 3.00. An intravenous infusion of piperacillin sodium and tazobactam sodium 4.5 g every 8 hours, intramuscular injection of compound aminophenazone and barbital 2 ml, oral loxoprofen sodium 30 mg and other drugs were added to his regimen for pulmonary infection and high fever. Before the drug combination, prothrombin time （PT） was 27 s, and the INR was 2.45. Two days later, the patient developed hemoptysis. The next day, warfarin sodium was stopped. On the second day of discontinuation of warfarin sodium,the patient suddenly felt a severe pain in the left upper abdomen with the sign of palpable mass and tenderness. Meanwhile, the PT was 42 s, and the INR was 4.46. On the next day, abdominal ultrasound examination showed that there was a cystic structure in the left abdominal rectus muscle with the size of 4.5 cm×2.7 cm×1.5 cm, and the internal circular high density shadow in the left rectus muscle was found on abdominal ultrasonography. Left abdominal rectus muscle hematoma was considered. Intramuscular injection of vitamin K1 10 mg once daily was given immediately, and ceftazidime was used instead of piperacillin sodium and tazobactam sodium. Two days later, the patient＇s symptoms of abdominal pain disappeared, PT fell to 16 s, INR fell to 1.11. One week later, oral warfarin sodium （initial dose 2.25 mg once daily）was given, and adjusted the dose according to INR. One month later, the abdominal ultrasound examination showed that the size of hematoma significantly decreased （3.5 cm × 0.8 cm）.
出处
《药物不良反应杂志》
CSCD
2015年第5期385-386,共2页
Adverse Drug Reactions Journal
关键词
华法林
腹直肌
血肿
vWarfarin
Rectus abdominis
Hematoma
