摘要
1例66岁男性患者因焦虑症、抑郁症给予劳拉西泮1 mg口服、2次/d,丁螺环酮10 mg口服、2次/d。2个月后,患者出现畏寒、发热、嗜睡,四肢僵硬等症状。实验室检查:白细胞计数13.5×109/L,中性粒细胞0.89,C反应蛋白68.7 mg/L,血肌酐211 mmol/L,直接胆红素10.3 mmol/L,丙氨酸转氨酶96 U/L,天冬氨酸转氨酶121 U/L,肌酸激酶4557 U/L,肌酸激酶MB 83 U/L,乳酸脱氢酶462 U/L,α-羟丁酸脱氢酶339 U/L,肌钙蛋白116 ng/L。考虑为丁螺环酮所致恶性综合征,停用该药,劳拉西泮继续使用,给予吸氧和心电监护、物理降温,抗感染等治疗。患者仍发热,并出现深度昏迷,尿液为茶色,肌红蛋白>3000 mg/L,考虑继发横纹肌溶解症。继续抗感染,并给予纠正电解质平衡、碱化尿液、利尿等治疗。停药第10天,患者四肢活动正常,尿色正常,肌酸激酶246 U/L、肌红蛋白856 mg/L。1个月后复查,各项检查无明显异常,患者未再出现恶性综合征症状。考虑恶性综合征继发横纹肌溶解症,可能主要与丁螺环酮有关,而与劳拉西泮的联用可能促进了其发生。
A 66-year-old male patient with anxiety and depression received lorazepam 1-mg twice daily and buspirone 10-mg twice daily.Two months later,the patient developed chills,fever,drowsiness,and stiffness of limbs,etc.Laboratory tests showed white blood cell count 13.5×10^(9)/L,neutrophils 0.89,C-reactive protein 68.7-mg/L,serum creatinine 211-mmol/L,direct bilirubin 10.3-mmol/L,alanine amino-transferase 96-U/L,aspartate aminotransferase 121-U/L,creatine kinase(CK)4-557-U/L,CK-MB 83-U/L,lactate dehydrogenase 462-U/L,α-hydroxybutyrate dehydrogenase 339-U/L,and troponin 116-ng/L.Malignant syndrome caused by buspirone was considered.The drug was stopped,lorazepam was continued,and oxygen inhalation,ECG monitoring,physical cooling,anti-infection,and other treatments were given.The patient still had fever and developed deep coma,with brown urine and myoglobin>3000-mg/L.Secondary rhabdomyolysis was considered.Anti-infection treatment was continued and treatments such as correcting electrolyte balance,alkalizing urine,and diuresis were given.On the 10th day of drug withdrawal,the patient had normal limb activity and urine color,his creatine kinase was 246-U/L,and myoglobin was 856-mg/L.One month later,the laboratory tests showed no obvious abnormalities and no malignant syndrome releted symptoms recurred.The rhabdomyolysis secondary to malignant syndrome in the patient was considered to be possibly related to buspiron and the combination with lorazepam might promote its occurrence.
作者
王冰
周广洁
李进峰
汤华颖
张爱纶
黄慧选
Wang Bing;Zhou Guangjie;Li Jinfeng;Tang Huaying;Zhang Ailun;Huang Huixuan(Department of Pharmacy,Weihai Municipal Hospital,Shandong Province,Weihai 264200,China;Department of General Surgery,Weihaiwei People′s Hospital,Shandong Province,Weihai 264200,China;Nursing Department,Weihai Municipal Hospital,Shandong Province,Weihai 264200,China)
出处
《药物不良反应杂志》
CSCD
2022年第4期220-222,共3页
Adverse Drug Reactions Journal
基金
山东省老年医学学会2021年科技攻关项目(LKJGG2021W123)。
