注射用炎琥宁致下肢震颤、抖动1例：案例报告及机制探讨

A Case of Lower Limb Tremor and Shaking Induced by Potassium Sodium Dehydroandrographolide Succinate for Injection: Case Report and Mechanism Discussion

关键词:  炎琥宁  下肢震颤  不良反应  

Key words:  Potassium Sodium Dehydroandrographolide Succinate  Lower limb tremor  Adverse drug reaction

摘要:

本研究报道1例72岁女性患者因使用注射用炎琥宁后出现下肢震颤、抖动的不良反应。患者因右股骨远端骨折入院，既往有高血压、脑出血后遗症和乙肝病史。在使用炎琥宁静滴后10余分钟，患者出现下肢震颤、抖动，停药30分钟后症状自然缓解。通过诺氏药物不良反应评估量表评估，结果提示该不良反应很可能由炎琥宁引起。结合患者病史、用药情况及文献回顾，推测其可能机制包括：血脑屏障穿透性改变、药物代谢特性转化与药物相互作用；神经递质系统失衡与运动环路调控异常；炎症信号通路抑制与神经元功能紊乱；过敏反应介导的神经炎症。本病例提示临床使用炎琥宁时需严格掌握适应症，警惕老年、脑血管病变及多药相互作用等风险因素，为炎琥宁神经系统不良反应机制研究及临床用药提供参考。

Abstract:

This study reports a case of a 72-year-old female patient who experienced adverse reactions of lower limb tremors and shaking after the use of injectable Potassium Sodium Dehydroandrographolide Succinate. The patient was admitted to the hospital due to a fracture of the distal femur and had a history of hypertension, sequelae of cerebral hemorrhage, and hepatitis B. After intravenous infusion of Potassium Sodium Dehydroandrographolide Succinate for more than 10 minutes, the patient developed lower limb tremors and shaking, which naturally resolved 30 minutes after discontinuation of the drug. Assessment using the Naranjo Adverse Drug Reaction (ADR) Evaluation Scale suggested that the adverse reaction was likely caused by Potassium Sodium Dehydroandrographolide Succinate. Based on the patient's medical history, medication use, and a review of the literature, the possible mechanisms were speculated to include: changes in blood-brain barrier permeability, transformation of drug metabolic characteristics, and drug interactions; imbalance of the neurotransmitter system and abnormal regulation of the motor circuit; inhibition of inflammatory signaling pathways and neuronal dysfunction; and neuroinflammation mediated by allergic reactions. This case highlights the need for strict adherence to indications when using Potassium Sodium Dehydroandrographolide Succinate in clinical practice and the importance of being vigilant about risk factors such as the elderly, cerebrovascular diseases, and polypharmacy. It also provides insights for the study of the mechanisms of Potassium Sodium Dehydroandrographolide Succinate-induced neurological adverse reactions and clinical medication use.