背景:5-羟色胺综合征是一种潜在的危及生命的疾病,可能是治疗性使用5-羟色胺能药物或药物相互作用的结果。在这项研究中,我们描述了2例使用利奈唑胺后5-羟色胺综合征相关的高血压危象.
方法:首例患者是一名52岁女性,因糖尿病足感染和意识水平下降相关的肺炎入院。开始使用利奈唑胺后24小时出现5-羟色胺综合征。顽固性高血压是主要的血流动力学发现。用氨氯地平无法控制,缬沙坦,哌唑嗪,和硝酸甘油输液.在停止使用利奈唑胺约48小时后,顽固性高血压和5-羟色胺综合征的其他症状得到缓解。第二个病例是一个有肾移植史的人,糖尿病,和高血压。他因严重的COVID-19广谱抗生素[利奈唑胺,头孢吡肟],Remdesivir开始了.插管后,连续输注芬太尼用于镇静.芬太尼和利奈唑胺开始后24小时内,剧烈的躁动,眼睛阴云,反射亢进,高血压[160-186/90-110mmHg],并注意到心动过速[>100/min]。随着血清素综合征的可能诊断,停用芬太尼,吗啡开始了。停用芬太尼48小时后,患者症状改善。
结论:两名患者均有高血压控制病史。然而,5-羟色胺综合征发生在利奈唑胺和同时/最近使用5-羟色胺能药物后。全面评估患者的病史和现状可以帮助临床医生预防危重患者的这种综合征。
BACKGROUND: Serotonin syndrome is a potentially life-threatening condition that can occur as a result of the therapeutic use of serotonergic medications or drug interaction. In this study, we describe two cases of serotonin syndrome-associated hypertensive crisis following
linezolid use.
METHODS: The first patient was a 52-year-old female who was admitted due to a diabetic foot infection and pneumonia associated with a decreased consciousness level. Serotonin syndrome occurred 24 hours after starting the
linezolid use. Resistant hypertension was the main hemodynamic finding. It could not be controlled with amlodipine, valsartan, prazosin, and nitroglycerin infusion. Resistant hypertension and other symptoms of serotonin syndrome were resolved about 48 hours after discontinuation of linezolid use. The second case was a man with a history of kidney transplant, diabetes, and hypertension. He was admitted to the ICU due to severe COVID-19 broad-spectrum antibiotics [
linezolid, cefepime], and remdesivir was initiated. Following intubation, continuous infusion of fentanyl was used for sedation. Within 24 hours after fentanyl and
linezolid initiation, severe agitation, eye clonus, hyperreflexia, hypertension [160-186 /90-110 mmHg], and tachycardia [>100/min] were noted. With the possible diagnosis of serotonin syndrome, fentanyl was discontinued, and morphine was initiated. The patient\'s symptoms improved 48 hours after discontinuation of fentanyl.
CONCLUSIONS: Both of the patients had a history of controlled hypertension. However, serotonin syndrome occurred following the use of
linezolid and concomitant/recent use of serotonergic agents. A thorough evaluation of the patient\'s medical history and current situation can help clinicians prevent this syndrome in critically ill patients.