中国药物警戒 ›› 2020, Vol. 17 ›› Issue (11): 841-844.
DOI: 10.19803/j.1672-8629.2020.11.21

• 安全与合理用药 • 上一篇    下一篇

注射用两性霉素B脂质体鞘内注射致神经系统毒性1例分析

杨敏1, 杨勇2, 周捷1   

  1. 1绵阳市中心医院药学部,四川 绵阳 621000;
    2四川省人民医院药学部,四川 成都 610072
  • 收稿日期:2020-11-10 修回日期:2020-11-10 出版日期:2020-11-15 发布日期:2020-11-10
  • 通讯作者: *周捷,女,本科,副主任药师,临床药学。E-mail:641083467@qq.com
  • 作者简介:杨敏,女,硕士,主管药师,临床药学。

One Case of Nervous System Toxicity Induced by Amphotericin B Liposomes via Intrathecal for Injection

YANG Min1, YANG Yong2, ZHOU Jie1   

  1. 1Department of Pharmacy, Mianyang Central Hospital, Mianyang Sichuan 621000, China;
    2Department of Pharmacy, the People's Hospital of Sichuan Province, Chengdu Sichuan 610072, China
  • Received:2020-11-10 Revised:2020-11-10 Online:2020-11-15 Published:2020-11-10

摘要: 目的 对小儿隐球菌脑膜炎抗感染治疗过程中出现的神经系统毒性反应进行分析,总结儿童特殊人群中两性霉素B制剂鞘内注射不良反应的经验和教训,为临床用药提供借鉴。方法 梳理患儿住院治疗经过、用药情况及发生不良反应的时间、表现、处理及转归,查阅文献及相关诊治指南,分析患儿发生不良反应可能的原因,并给出相应处理措施。结果 两性霉素B脂质体鞘内注射致患儿出现不良反应可能性大,小儿心理应激可对治疗有一定负面影响。经停用鞘内注射及给予一定心理疏导,患儿不良反应好转。结论 鞘内注射引起神经毒性反应风险大,对于非难治性隐球菌脑膜炎不应常规给予鞘内注射。确需鞘内注射两性霉素B时,应避免选用两性霉素B脂质体。儿科患者心理承受能力较弱,有条件时应给予心理疏导,可优化治疗反应。

关键词: 两性霉素B脂质体, 鞘内注射, 神经系统毒性

Abstract: Objective To analyze the nervous system toxicity induced by amphotericin B liposomes delivered by intrathecal injection in a patient with pediatric cryptococcal meningitis in order to help reduce adverse reactions in pediatrics. Methods Data on the patient's process of hospitalization, therapeutic regimen, time of occurrence and prognosis of adverse reactions was collected. The related literature and diagnosis and treatment guidelines were reviewed, possible causes of adverse reactions were analyzed and corresponding treatment measures were recommended. Results It was likely that the adverse reactions were caused by the intrathecal injection of amphotericin B liposomes. After discontinuation of intrathecal injection and psychological counseling, the adverse reactions were relieved. Conclusion There is a high risk of neurotoxic reactions when amphotericin B is administrated by intrathecal injection, so intrathecal injection should not be routinely recommended for cases of non-refractory cryptococcal meningitis. Amphotericin B liposomes should be avoided when intrathecal injection is needed. Given the weak psychological capacity of pediatric patients, appropriate psychological counseling could optimize the treatment response.

Key words: amphotericin B liposomes, intrathecal injection, nervous system toxicity

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