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2例精神病患者因肺部感染静脉滴注万古霉素致肾衰竭死亡。例1为84岁男性精神病患者,因肺部感染和呼吸衰竭行气管切开。给予患者糖皮质激素、头孢他啶及依替米星治疗,后改为万古霉素1g,2次/d,静脉滴注。患者的Cr和BUN水平用药前为分别为71μmol/L和7.3mmol/L;治疗第9天分别升至223μmol/L和27.3mmol/L。患者尿量由1930ml(治疗第6天)减少至650ml(治疗第8天)。患者出现肺栓塞、急性肾衰竭、代谢性酸中毒、心律失常及浅昏迷,最后经抢救无效死亡。例2为58岁女性精神病患者,因肺部感染给予头孢吡肟、亚胺培南-西司他丁及低分子肝素钙,后改为万古霉素1g,2次/d,静脉滴注。患者的Cr和BUN水平用药前分别为87μmol/L和7.5mmol/L,用药第3天分别升至124μmol/L和14.7mmol/L,用药第6天分别升至436μmol/L和30.1mmol/L。患者尿量自用药第3天下降至900ml,用药第6天下降至200ml,并出现腹泻。诊断为急性肾衰竭,停用万古霉素,经抢救无效,于停用万古霉素第3天死亡。
Two psychiatric patients died of renal failure due to vancomycin intravenous infusion of pulmonary infection. Example 1 An 84-year-old male patient with mental illness who had tracheotomy due to pulmonary infection and respiratory failure. Patients given glucocorticoid, ceftazidime and etimicin treatment, later changed to vancomycin 1g, 2 times / d, intravenous drip. The levels of Cr and BUN in patients before treatment were 71μmol / L and 7.3mmol / L, respectively, and rose to 223μmol / L and 27.3mmol / L on the 9th day of treatment, respectively. The patient’s urine output decreased from 1930 ml (day 6 of treatment) to 650 ml (day 8 of treatment). Patients with pulmonary embolism, acute renal failure, metabolic acidosis, arrhythmia and coma, and finally died of death by rescue. Example 2 A 58-year-old female patient with mental illness was given intravenous infusion of cefepime, imipenem-cilastatin and low molecular weight heparin due to pulmonary infection, followed by 1 g vancomycin twice a day. The levels of Cr and BUN in patients before treatment were 87μmol / L and 7.5mmol / L, respectively. The levels of Cr and BUN were increased to 124μmol / L and 14.7mmol / L on the third day, and rose to 436μmol / L and 30.1mmol / L on the sixth day . The patient’s urine output dropped to 900ml on the third day after administration, and dropped to 200ml on the sixth day after the medication, and diarrhea occurred. Diagnosed with acute renal failure, vancomycin was discontinued, died after 3 days vancomycin was discontinued.