Page 101 - 《中国药房》2023年17期

·药物与临床·

1 例儿童输注万古霉素致全血细胞减少症合并迟发型药物热的
病例分析
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陈晓旭 ，吴非燃 ，李洪盟 ，荆自伟 ，张 辉 （1.郑州大学第一附属医院药学部，郑州 450052；2.河南省洛阳
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正骨医院脊柱微创外科，郑州 450016；3.郑州大学第一附属医院小儿外科，郑州 450052）
中图分类号 R969.3；R978.1 文献标志码 A 文章编号 1001-0408（2023）17-2139-05
DOI 10.6039/j.issn.1001-0408.2023.17.16

摘 要 目的 准确识别万古霉素较罕见的药品不良反应（ADR）——全血细胞减少症，以促进该药的安全使用。方法 通过1例化
脓性髋关节炎患儿静脉输注万古霉素后发生全血细胞减少症合并迟发型药物热的病例报告，采用Naranjo评分结合文献资料，评
估该ADR与治疗药物的关系及其可能的发生机制，提出儿童患者合理使用万古霉素的建议。结果与结论 该患儿发生的全血细胞
减少症合并迟发型药物热与万古霉素的关联性为“很可能”。临床上全血细胞减少症合并迟发型药物热与感染加重导致的发热、
血细胞减少较难区分，医护人员应提高对全血细胞减少症等万古霉素较罕见ADR的警觉性，药师应协助医护人员及时甄别ADR。
儿童输注万古霉素初始剂量宜从60 mg/（kg·d）开始，且应在首次用药后48 h进行血药浓度监测并及时调整剂量，使万古霉素谷浓
度维持在5～15 mg/L，以防止因血药浓度过高导致ADR的发生；对于万古霉素使用超过1周的患儿，应定期复查血常规，一旦发
生全血细胞减少应立即停药，并根据情况给予对症治疗。
关键词 万古霉素；儿童；全血细胞减少症；迟发型药物热；病例分析

Analysis of a case of pancytopenia complicated with delayed drug fever induced by vancomycin infusion in
a child
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CHEN Xiaoxu ，WU Feiran ，LI Hongmeng ，JING Ziwei ，ZHANG Hui （1. Dept. of Pharmacy， the First
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Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China；2. Dept. of Minimal Invasive Spinal
Surgery， Luoyang Orthopedic-Traumatological Hospital of Henan Province， Zhengzhou 450016， China；3. Dept.
of Pediatric Surgery， the First Affiliated Hospital of Zhengzhou University， Zhengzhou 450052， China）
ABSTRACT OBJECTIVE To accurately identify the rare adverse drug reactions （ADR） of vancomycin-pancytopenia in order to
promote its safe use. METHODS Through a case report of a child with suppurative hip arthritis who developed pancytopenia
combined with delayed drug fever caused by intravenous infusion of vancomycin，Naranjo score method and related literature were
used to summarize the association between the ADR and vancomycin and its possible mechanism， and suggestions for rational use
of vancomycin in pediatric patients were put forward. RESULTS & CONCLUSIONS The association of pancytopenia combined
with delayed drug fever and vancomycin in this child is “very likely”. In clinical practice， it is difficult to distinguish between
pancytopenia combined with delayed drug fever from fever and hematopenia caused by aggravation of infection. Medical staff
should increase their awareness of vancomycin rare ADR such as pancytopenia， and pharmacists should assist medical staff in
timely screening for ADR. The initial dose of vancomycin infusion for children should start from 60 mg/（kg·d），and the blood
concentration should be monitored 48 h after the first infusion and the dose should be adjusted in time to maintain the valley
concentration of vancomycin at 5-15 mg/L to prevent the occurrence of ADR caused by excessive blood concentration. For children
who have been using vancomycin for more than one week，the blood routine should be rechecked regularly. Once pancytopenia
occurs，the drug should be stopped immediately，and symptomatic treatment should be given according to the situation.
KEYWORDS vancomycin； children； pancytopenia； delayed drug fever； case analysis

Δ 基金项目 国家自然科学基金项目（No.82003956）；河南省医学
科技攻关计划（联合共建）项目（No.LHGJ20190277） 万古霉素是一种糖肽类抗菌药物，临床主要用于治
＊第一作者 主管药师，硕士。研究方向：医院药学、临床药理。电 疗革兰氏阳性球菌引起的严重感染，尤其是甲氧西林耐
话：0371-66967015。E-mail：xiaoxuC_hust@163.com
药的金黄色葡萄球菌（methicillin-resistant Staphylococ‐
# 通信作者 主治医师，硕士。研究方向：小儿骨科。电话：0371-
66967252。E-mail：297069266@qq.com cus aureus，MRSA）引起的感染。其常见药品不良反应

中国药房 2023年第34卷第17期 China Pharmacy 2023 Vol. 34 No. 17 · 2139 ·