摘要
目的探讨盐酸替罗非班诱发的重度血小板减少症(GIT)的临床特点、发病原因、鉴别诊断要点及防治策略,为临床安全用药提供参考。方法对我院收治的1例急性冠状动脉综合征(ACS)患者应用盐酸替罗非班过敏导致重度GIT的临床资料进行回顾性分析,并复习相关文献。结果患者用药前血小板计数正常,应用盐酸替罗非班约10 min后出现全身发冷、颤动,伴呼吸困难,停药并且给予糖皮质激素治疗后症状迅速缓解,但第2天血小板计数严重下降,最低血小板计数30×109/L,无出血表现,继续给予阿司匹林及氯吡咯雷抗血小板及低分子肝素抗凝治疗,未输注血小板及进一步给予糖皮质激素或免疫球蛋白治疗,血小板计数逐渐升高,约96h恢复正常。结论 ACS患者应用盐酸替罗非班疗效确切,但在应用早期,尤其24 h内可出现GIT,出现过敏表现时,不应作为简单的变态反应处理,应警惕替罗非班诱导的GIT发生,及时复查血小板计数,确保临床用药安全。
Objective To explore the clinical characteristics,etiologies,differential diagnosis and control strategy for severe tirofiban-induced thrombocytopenia（ GIT）,and provide information for clinical practice. Methods The clinical data of 1 patient diagnosed with acute coronary syndrome（ ACS）,who was treated with tirofiban admitted to our hospital,was collected and retrospectively analyzed,and related literatures were reviewed. Results The count of platelets was normal in the case before medication; shivering and respiratory distress occurred in 10 min after administration of tirofiban,and drug administration of tirofiban was immediately halted; anti-anaphylactic treatment,such as glucocorticoids,was actively adopted,and the patient＇s clinical manifestations were relieved rapidly. The count of platelets seriously declined on the next day. The minimal count of platelets was 30. 0 × 109/L without manifestation of bleeding. The antithrombotic and anticoagulant therapy countinued,without platelet infusion of treatment with glucocorticoids or immunoglobulin,the count of platelets recovered after 96 h. Conclusion The clinical efficacy of tirofiban on ACS is definite,but we should be on guard against the occurrence of GIT during early stage of tirofiban treatment,especially in24 h. When allergic reactions caused by tirofiban occur,the count of platelets should be detected in time in order to ensure safety in clinical medication instead of being treated as a simple allergic reaction.
出处
《实用药物与临床》
CAS
2017年第11期1278-1282,共5页
Practical Pharmacy and Clinical Remedies
