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本文报道1例静脉应用红霉素后出现一过性心肌功能不全及反复发作的扭转型室速.患者女性,32岁,诊断系统性红斑狼疮、胰岛素依赖型糖尿病、肾移植后慢性排异反应、右下叶肺炎.否认心脏病史.心电图示窦性心动过速,QTc间期448ms.遂应用红霉素1g q6h,30～60min滴完;万古霉素iv,q72h;甲硝唑 500mgq8h.治疗后临床情况改善.第2天超声心动图示轻度左室肥厚,估测射血分数53%.抗生素治疗约60h患者出现心室颤动,此时血清钾偏低(2.7mEq/L).电转复后室颤去除,血钾亦恢复正常,转至加强监护病房治疗.当日又出现短阵扭转型室速,持续30min,经心前区叩击终止,复苏后心电图示窦性心律,QTc间期547ms,T波电交替,明显U波.
This article reports a case of transient myocardial ventricular tachycardia and recurrent torsades de pointes after a single intravenous administration of erythromycin.A female patient, 32 years old, diagnosed with systemic lupus erythematosus, insulin-dependent diabetes mellitus, chronic rejection after renal transplantation , Right lower lobe pneumonia. Denied the history of heart disease. ECG showed sinus tachycardia, QTc interval 448ms. Then the application of erythromycin 1g q6h, 30 ~ 60min dripping finished; vancomycin iv, q72h; metronidazole 500mgq8h. Post-clinical echocardiography was performed on day 2. Echocardiography showed mild left ventricular hypertrophy with an estimated ejection fraction of 53%. Ventricular fibrillation was observed in patients treated with antibiotics for approximately 60 hours, when serum potassium was low (2.7 mEq / L) After the removal of ventricular fibrillation, serum potassium also returned to normal, go to intensive care unit treatment.On the same day there are short-term torsades-type ventricular tachycardia, sustained 30min, percussion before the termination of the area, after the recovery of ECG showed sinus rhythm, QTc interval 547ms, T wave alternating, obviously U wave.