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1例73岁男性患者,因心房颤动给予胺碘酮治疗。800mg/d静脉滴注1周后,改为口服600mg/d1个月、400mg/d2个月、200mg/d3个月。用药6个月后患者出现干咳、气促。肺CT示双肺呈间质性改变。实验室检查示:WBC22.68×109/L,N0.76,BUN11.20mmol/L,SCr182μmol/L。pH值7.36,PO235mmHg,PCO249mmHg,SaO264%。考虑为胺碘酮所致肺间质纤维化合并感染。给予面罩吸氧,左氧氟沙星0.5g静脉滴注,1次/d,头孢哌酮-舒巴坦3.0g静脉滴注,2次/d;甲泼尼龙40mg静脉滴注,2次/d及乙酰半胱氨酸0.6g,口服2次/d。治疗第14天患者肺弥散功能严重下降,重度低氧血症(SaO2曾降至50%以下);BUN18.90mmol/L,SCr286μmol/L,尿量200mL/d以下。入院第21天检查示BUN24.10mmol/L,SCr357μmol/L。患者血压明显下降伴频发心房颤动,终因多脏器衰竭和肺部感染死亡。
A 73-year-old man with amiodarone was given atrial fibrillation. 800mg / d intravenous infusion for 1 week, changed to oral 600mg / d1 months, 400mg / d2 months, 200mg / d3 months. 6 months after treatment, patients with dry cough, shortness of breath. Pulmonary CT showed interstitial lung changes. Laboratory tests showed: WBC22.68 × 109 / L, N0.76, BUN11.20mmol / L, SCr182μmol / L. pH 7.36, PO235mmHg, PCO249mmHg, SaO264%. Consider amiodarone-induced pulmonary interstitial fibrosis infection. Given oxygen mask, levofloxacin 0.5g intravenous infusion, 1 / d, cefoperazone - sulbactam 3.0g intravenous infusion, 2 times / d; methylprednisolone 40mg intravenous infusion, 2 times / d and acetyl half Cystine 0.6g, oral 2 times / d. On the 14th day of treatment, the patient’s lung diffusion function was severely decreased, severe hypoxemia (SaO2 had dropped to below 50%); BUN18.90mmol / L, SCr286μmol / L, urine output below 200mL / d. Admission on the 21st day showed BUN24.10mmol / L, SCr357μmol / L. The patient’s blood pressure decreased significantly with frequent atrial fibrillation and eventually died of multiple organ failure and pulmonary infection.