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本文报告1例速尿引起的急性胰腺炎。患者系64岁女性,因心肌梗死伴轻度左室衰竭入院,当时情况尚好。入院后肌注双氢可待因1次,口服速尿40毫克/日、氯化钾16毫当量/日。4天后病人前胸痈加剧,心电图示梗死扩大,遂用吗啡止痛,速尿及氯化钾剂量加倍。至第4周末,发生呃逆、暖气和上腹不适,10天后出现呕吐,右季肋区压痛和肌卫。血浆胆红素1.7毫克/100毫升,血清淀粉酶80单位/100毫升(正常<33单位/100毫升),血清脂酶3.3单位/毫升(正常<1单位/毫升)。诊断为急性胰腺炎。入院第7周停用速尿及氯化钾,36小时内腹痛明显减轻,暖气和呕吐亦减少,血清淀粉酶和脂酶开始下降;2周后病情继续改善,血清淀粉酶和脂酶恢复近正常。胆囊造影正常。入院第10周末,症状已消失10天,再服速尿40毫克/日,次日即主诉上腹不适和暖气,第5天出现上腹痛和压痛,血清淀粉酶和脂酶复又升高。当天停用速尿,36小时内症状明显改善,血清淀粉酶和脂酶开始下降,出院后3个月均已降至正常。作者根据上述观察,排除了其他原因引起胰腺炎的可能,认为胰腺炎系由速尿引起。
This article reports a case of acute pancreatitis caused by furosemide. The patient, a 64-year-old woman admitted to hospital with myocardial infarction with mild left ventricular failure, was in good condition. Intramuscular injection of hydrocodone 1, oral furosemide 40 mg / day, potassium chloride 16 meq / day. 4 days after the patient chest anterior exacerbation, ECG infarction to expand, then morphine analgesic, furosemide and potassium chloride doubles. By the fourth weekend, hiccups, heating and abdominal discomfort occurred, vomiting after 10 days, right quarter rib tenderness and myo-Wei. Plasma bilirubin 1.7 mg / 100 ml, serum amylase 80 units / 100 ml (normal <33 units / 100 ml), serum lipase 3.3 units / ml (normal <1 unit / ml). Diagnosis of acute pancreatitis. In the 7th week of hospitalization, the use of furosemide and potassium chloride was discontinued in the 7th week. Abdominal pain was relieved within 36 hours, the heating and vomiting also decreased, and serum amylase and lipase began to decline. After 2 weeks, the disease continued to improve and serum amylase and lipase recovered normal. Gallbladder imaging normal. On the 10th weekend of hospital admission, the symptoms disappeared for 10 days, then sublethal 40 mg / day. The day after the main complaint of abdominal discomfort and heating, abdominal pain and tenderness appeared on the 5th day, and serum amylase and lipase complex increased again. On the day of derailment, the symptoms improved significantly within 36 hours, serum amylase and lipase began to decline, and were all reduced to normal within 3 months after discharge. According to the above observations, the author ruled out the possibility of other causes of pancreatitis, pancreatitis is caused by furosemide.