摘要
1例74岁男性高血压病患者因失语伴右侧肢体活动不利3 h入院，诊断为急性脑梗死。入院后1 h 17 min给予阿替普酶（浓度为1 mg/ml）溶栓治疗，先予6.48 mg静脉注射（1-2 min内注射完毕），后续58.32 mg静脉泵入。给药后约10 min，患者突发面色苍白、全身大汗、四肢冰冷、神志不清，血压从169/89 mmHg（1 mmHg=0.133 kPa）降至112/68 mmHg。考虑为阿替普酶过敏反应，立即停用该药，给予吸氧、补液，同时给予多巴胺、苯海拉明、地塞米松以及其他抗过敏及抗休克药物。次日上午，患者出现贫血，RBC 2.12×10^12/L，Hb 66 g/L。当晚，发现其右侧臀部（在注射部位）至大腿深肌层出现血肿。考虑为阿替普酶所致外周血肿。入院第3天，患者发生脑疝，应家属要求出院。
A 74-year-old male patient with hypertension was admitted to hospital because of aphasia and movement disorder of his right limb for 3 hours. He was diagnosed as acute cerebral infarction. Thrombolytic therapy with alteplase （1 mg/ml） was given 1 hour and 17 minutes after admission. Intravenous injection of alteplase 6.48 mg was given firstly （within 1-2 minutes of completing the injection） and then 58.32 mg was administered intravenously via an infusion pump. About 10 minutes after treatment with alteplase, the patient suddenly developed pallor, drenching sweats, cold limbs, and unconsciousness; his blood pressure dropped from 169/89 mmHg to 112/68 mmHg. Alteplase-induced anaphylaxis was considered. Alteplase was immediately stopped and oxygen inhalation and liquid supplements were given. At the same time, dopamine, diphenhydramine, dexamethasone, and other anti-anaphylactic and anti-shock agents were immediately given. The next morning, the patient developed anemia, RBC 2.12×10^12/L, Hb 66 g/L. That night, hematoma appeared in his deep muscle from the right hip （at the injection site） to thigh. The peripheral hematoma was considered to be induced by alteplase. On the 3rd day of admission, the patient developed cerebral palsy and was discharged by his family′s request.
作者
周晶亮
管晓东
吴忻晶
彭宾宾
Zhou Jirtgliang;Guan Xiaodong;Wu Xinjing;Peng Birtbin(Quality Control Office,Yuncheng Central Hospital,Shanxi Province,Yuncheng 044000,Chin)
出处
《药物不良反应杂志》
CSCD
2018年第3期226-227,共2页
Adverse Drug Reactions Journal
