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1例80岁男性患者因术后感染给予亚胺培南西司他汀钠、万古霉素、卡泊芬净、米卡芬净及美罗培南,效果不佳,后治疗改为联用美罗培南1.0 g,1次/8 h静脉滴注及伏立康唑200 mg(首日剂量400 mg,1次/12 h),1次/12 h静脉滴注。第5～9天,实验室检查示血清肌酐(SCr)154～208μmol/L,尿素氮(BUN)24.3～35.9 mmol/L,血清胱抑素C 4.54～5.44 mg/L;血pH值7.18～7.34,氯离子122～130 mmol/L,钾离子3.4～4.1 mmol/L,标准碳酸氢盐波动于12～15 mmol/L,实际碳酸氢盐13～14 mmol/L,阴离子间隙13～14 mmol/L。尿分析示红细胞3.8～4.8个/HP,蛋白±,pH值保持在5.5。诊断为肾小管性酸中毒、急性肾损伤。第9天,伏立康唑用法改为每晨静脉滴注200 mg,每晚鼻饲给药200 mg。调整用法后第3天患者出现高氯性酸中毒、低钾血症,第11天停用伏立康唑,美罗培南继续应用。停药2 d后,患者血清SCr及BUN水平升至最高,分别达282μmol/L及49.4 mmol/L,随后逐渐降低,分别于停药后第25天和停药后34天降至正常,血气分析各项指标于停药后第25天基本恢复正常。
One 80-year-old male patient was ineffective with imipenem cilastatin sodium, vancomycin, micafungin, micafungin and meropenem due to postoperative infection, and post-treatment was switched to meropenem 1.0 g , 1/8 h intravenous infusion and voriconazole 200 mg (400 mg first day, 1/12 h), 1/12 h intravenous infusion. From the 5th to the 9th day, the laboratory tests showed that serum creatinine (SCr) was 154 ~ 208μmol / L, BUN was 24.3 ~ 35.9 mmol / L, serum cystatin C was 4.54 ~ 5.44 mg / L, blood pH was 7.18 ~ 7.34 Chloride ions 122-130 mmol / L Potassium ions 3.4-4.1 mmol / L Standard bicarbonate fluctuations 12-15 mmol / L Actual bicarbonate 13-14 mmol / L Anion gaps 13-14 mmol / L. Urine analysis showed red blood cells 3.8 ~ 4.8 / HP, protein ±, pH value maintained at 5.5. Diagnosis of renal tubular acidosis, acute kidney injury. On day 9, voriconazole use was changed to 200 mg intravenous infusion every morning and 200 mg nasal feeding per night. On day 3 after adjustment for use, patients developed hyperchlorinated acidosis and hypokalemia, voriconazole was discontinued on day 11, and meropenem continued. Serum levels of SCr and BUN rose to the highest levels of 282 μmol / L and 49.4 mmol / L, respectively, after 2 days of withdrawal, and then gradually decreased. The levels of SCr and BUN decreased to normal after 25 days of withdrawal and 34 days after withdrawal, respectively. Analysis of various indicators in the first 25 days after stopping basically returned to normal.