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1例76岁女性患者因肺部感染合并冠状动脉粥样硬化性心脏病给予静脉注射头孢哌酮钠/舒巴坦钠1.5 g、3次/d,生脉注射液40 ml/d,丹参酮ⅡA磺酸钠注射液60 mg/d,单硝酸异山梨酯注射液10 mg/d。治疗第4天患者出现凝血功能异常,凝血酶原时间(PT)58.4 s,凝血酶原活动度(PTA)13%,国际标准化比值(INR)3.83,活化部分凝血活酶时间(APTT)38.5 s。第5天停用丹参酮ⅡA磺酸钠注射液。第7天患者凝血功能障碍加重,PT 105.8 s,PTA 5.8%,INR 7.02,APTT 49.7 s。第12天,因考虑凝血功能障碍可能与头孢哌酮钠/舒巴坦钠输注相关,立即停药,其余治疗药物继续应用。患者当晚出现全程肉眼血尿,颏部可见瘀斑。第13天患者呕吐鲜血,APTT 99.4 s,立即输注新鲜冰冻血浆,静脉滴注卡络磺钠,肌内注射维生素K1。第15天患者复查凝血功能:PT 11.00 s,PTA 123.3%,INR 1.048,APTT 30.10 s。
A 76-year-old woman with pulmonary infection and coronary heart disease was given cefoperazone sodium / sulbactam sodium 1.5 g, 3 times / d, Shengmai injection 40 ml / d, tanshinone Ⅱ A sodium sulfonate Injection 60 mg / d, isosorbide mononitrate injection 10 mg / d. Patients on the fourth day of treatment had coagulation abnormalities, prothrombin time (PT) 58.4 s, prothrombin activity 13%, INR 3.83, and activated partial thromboplastin time (APTT) 38.5 s . Danshinone Ⅱ A sodium sulfonate injection was discontinued on the 5th day. On day 7, the coagulation dysfunction was aggravated with PT 105.8 s, PTA 5.8%, INR 7.02, and APTT 49.7 s. The 12th day, due to consider coagulation disorders may be associated with cefoperazone sodium / sulbactam sodium infusion, immediate withdrawal, the remaining therapeutic drugs continue to be used. The patient appeared the whole night gross hematuria, chin visible bruises. On the thirteenth day, the patient vomited blood, APTT 99.4 s, immediately infusion of fresh frozen plasma, intravenous infusion of sodium kasugam sodium, intramuscular injection of vitamin K1. On the 15th day, patients were examined for coagulation function: PT 11.00 s, PTA 123.3%, INR 1.048, APTT 30.10 s.