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头孢曲松为临床广泛应用的第三代头孢菌素类抗生素,其常见不良反应有过敏反应和胃肠道反应。头孢曲松还可引起溶血性贫血,近年报道日益增多。本文从国内外文献检索到头孢曲松引起的免疫性溶血性贫血21例,其中国外报道16例,死亡8例;国内报道5例,死亡1例。头孢曲松钠的剂量一般为1~4 g,溶血反应发生的时间从用药后数分钟到数天不等。临床表现为头晕、心悸、呼吸急促、腰痛,并伴有血尿、蛋白尿等;血红蛋白值低于正常,血清学检查直接Coombs试验阳性。其发生机制主要为免疫复合物反应。本症十分罕见,但死亡率高。一旦发生溶血反应,应立即停药,静脉给予地塞米松,输注洗涤红细胞并碱化尿液。
Ceftriaxone is a third-generation cephalosporin antibiotic widely used clinically, and its common adverse reactions are allergic reactions and gastrointestinal reactions. Ceftriaxone can also cause hemolytic anemia, increasing reports in recent years. This article retrieved from domestic and foreign literature to ceftriaxone-induced immune hemolytic anemia 21 cases, of which 16 cases were reported in foreign countries, 8 cases of death; 5 cases reported in China, 1 case of death. The dose of ceftriaxone sodium is generally 1 ~ 4 g, the time of hemolytic reaction occurs from a few minutes to several days after treatment. Clinical manifestations of dizziness, palpitations, shortness of breath, back pain, accompanied by hematuria, proteinuria; hemoglobin values lower than normal, serological tests directly Coombs test positive. Its mechanism is mainly immune complex reaction. This disease is very rare, but the high mortality rate. Once the hemolysis reaction should be immediately discontinued, intravenous dexamethasone, infusion of washed red blood cells and alkalinization of urine.