Oude Munnik Thijs H, Annink-Smoors Marjon, Hom Harold W, Sportel Esther T
Medisch Spectrum Twente, Enschede.
Ned Tijdschr Geneeskd. 2016;160:A9464.
Metamizole is an analgesic, the orally administered form of which was withdrawn in the Netherlands in 1989 due to an unacceptably high incidence of agranulocytosis. However, later studies showed a much lower incidence and since 2013 the use of metamizole has been recommended by the national guideline on postoperative pain.
A 58-year-old woman was referred by her general practitioner to our hospital with suspected diverticulitis. Three days previously the patient had returned from a four-week period of rehabilitation at a German spa following hip replacement surgery. She had been using metamizole since the operation. Within hours of admission, the patient developed septic shock and was transferred to the intensive care unit. Laboratory tests revealed severe neutropenia of 0.2 × 10(9)/l. Treatment consisted of filgrastim, piperacillin/tazobactam and haemodynamic support. After five days the patient was sufficiently recovered to return to the ward.
Metamizole-related agranulocytosis is rare but potentially life-threatening. This condition is expected to occur more frequently as the use of metamizole in the Netherlands increases.
安乃近是一种镇痛药，其口服剂型于1989年在荷兰因粒细胞缺乏症发生率过高而被停用。然而，后来的研究显示其发生率要低得多，自2013年以来，术后疼痛的国家指南推荐使用安乃近。
一名58岁女性被全科医生转诊至我院，怀疑患有憩室炎。三天前，该患者在德国一家温泉疗养院进行了为期四周的髋关节置换术后康复治疗后返回。自手术后她一直在使用安乃近。入院数小时内，患者出现感染性休克并被转入重症监护病房。实验室检查显示严重中性粒细胞减少，为0.2×10⁹/L。治疗包括使用非格司亭、哌拉西林/他唑巴坦以及血流动力学支持。五天后，患者恢复良好，返回病房。
与安乃近相关的粒细胞缺乏症虽罕见但可能危及生命。随着荷兰安乃近使用量的增加，预计这种情况会更频繁地发生。
