静注人免疫球蛋白(pH4)致脑梗死1例

Intravenous injection of human immunoglobulin (pH4) induced cerebral infarction in 1 case

关键词:  静注人免疫球蛋白  脑梗死  不良反应

Key words:  intravenous human immunoglobulin  cerebral infarction  Adverse effects

摘要:

1例69岁女性患者诊断为抗合成酶综合征，因病情治疗需要接受静注人免疫球蛋白（PH4）(静脉滴注，D1-D2 10g/日、D3 20g/日、D4 20g /日、D5 10g /日)。患者用药D5后早晨自觉言语不利、肢体无力，急查颅脑MRI并邀请神经内科会诊，考虑存在新发脑梗死，结合患者病情并梳理所用药物，考虑静注人免疫球蛋白所致新发脑梗死。停用静注人免疫球蛋白，排除禁忌，予以注射用阿替普酶溶栓治疗，复查颅脑CT未见出血，并予以丁苯酞氯化钠注射液、注射用尤瑞克林、依达拉奉右莰醇注射用浓溶液、瑞舒伐他汀钙片等治疗。治疗7d后患者脑梗死较前明显好转，继续应用阿司匹林肠溶片联合氯吡格雷片双联抗血小板治疗，瑞舒伐他汀钙片调脂稳斑等对症治疗。出院后20d随访，患者脑梗死症状改善，未诉不适。

Abstract:

A 69-year-old female patient with a diagnosis of antisynthetase syndrome received intravenous human immunoglobulin (PH4) (intravenous drip, D1-D2 10g/day, D3 20g/day, D4 20g /day, D5 10g /day) for treatment of her condition. The patient was conscious of unfavorable speech and limb weakness in the morning after the use of drug D5, and urgent examination of cranial MRI and invitation of neurology consultation, considering the existence of new-onset cerebral infarction, combined with the patient's condition and combing the drugs used, considering the new-onset cerebral infarction caused by the static injection of human. immunoglobulin. Discontinue the sedation of human immunoglobulin, exclude contraindications, be injected with alteplase thrombolytic therapy, review of craniocerebral CT did not see hemorrhage, and be butylphthalide sodium chloride injection, injection of eurexin, edaravone dexamfetamine injectable concentrated solution, rasuvastatin calcium tablets adjuvant therapy. After 7d of treatment, the patient's cerebral infarction was significantly better than before, and he continued to apply aspirin enteric-coated tablets combined with clopidogrel tablets dual antiplatelet therapy, rishuvastatin calcium tablets to regulate lipids and stabilize the plaque, and other symptomatic treatment. After 20d follow-up after discharge, the patient's cerebral infarction symptoms improved and did not complain of discomfort.