论文部分内容阅读
1例86岁男性患者因肺炎、呼吸衰竭、痰细菌培养提示多重耐药铜绿假单胞菌感染,接受美罗培南(1 g静脉滴注、1次/12 h)联合乳酸环丙沙星氯化钠注射液(200 mg静脉滴注、1次/d)治疗。治疗第4天,患者突发血压下降,脉搏测不出,心电监护提示心室颤动(室颤)。给予电除颤及胺碘酮治疗后恢复窦性心律。次日再发3次室颤,急查电解质结果均正常,心电图检查示QT间期正常,停用环丙沙星,改为美罗培南联合磷霉素治疗,未再发生室颤。26 d后,患者肺炎加重,痰细菌培养回报仍为多重耐药铜绿假单胞菌,对环丙沙星敏感,对左氧氟沙星中度敏感。遂给予美罗培南(剂量用法同前)联合左氧氟沙星注射液(200 mg静脉滴注、1次/d)。治疗第5天,患者再次发生室颤,经电除颤及胺碘酮治疗后心律恢复正常。停用左氧氟沙星,改为美罗培南联合磷霉素,患者未再出现室颤。考虑患者的室颤可能与环丙沙星和左氧氟沙星有关。“,”An 86-year-old male patient received IV infusions of meropenem (1 g once per 12 hours) combined with ciprofloxacin lactate and sodium chloride injection (200 mg once daily) for pneumonia, respiratory failure, and multidrug resistant n Pseudomonas aeruginosa infection suggested by sputum bacterial culture. On the 4th day of treatments, the patient developed a sudden drop in blood pressure, and his pulse could not be measured. ECG monitoring suggested ventricular fibrillation. After the treatments of electric defibrillation and amiodarone injection, his sinus rhythm restored. The next day the patient had another three episodes of ventricular fibrillation. All electrolytes were normal during emergency examination and ECG examination showed that the QT interval was normal. Ciprofloxacin was discontinued and replaced by meropenem combined with fosfomycin, and ventricular fibrillation did not recur. Twenty-six days later, the patient′s pneumonia was aggravated and sputum bacterial culture result showed multidrug resistant n Pseudomonas aeruginosa infection, which was sensitive to ciprofloxacin and moderately sensitive to levofloxacin. Then meropenem (the same dosage and usage as before) combined with levofloxacin injection (200 mg once daily) were given. On the fifth day of treatments, the patient developed ventricular fibrillation again and his heart rhythm returned to normal after electric defibrillation and amiodarone treatment. Levofloxacin was discontinued and meropenem combined with fosfomycin were given again. Then ventricular fibrillation did not recur. The patient′s ventricular fibrillation was considered to be possibly related to ciprofloxacin and levofloxacin.n