Fox Ashley N, Villanueva Ruben, Miller Jamie L
University of Oklahoma College of Pharmacy, Oklahoma City, OK.
OU Medical Center, Oklahoma City, OK.
Am J Health Syst Pharm. 2017 Oct 1;74(19):1545-1548. doi: 10.2146/ajhp160737.
The case of a patient who experienced extravasation while receiving amiodarone via a peripheral infusion and was treated with intradermal hyaluronidase is reported.
A 60-year-old Caucasian man arrived at the emergency department after a motor vehicle collision. The patient was noted to have a subdural hematoma, multiple rib fractures, sternal body fracture, abdominal wall injury, left clavicle fracture, right humerus fracture, and vertebral fractures. His medical history included hypertension, atrial fibrillation, and stroke with residual right-sided weakness. On postoperative day 1, the patient developed atrial fibrillation and was started on i.v. amiodarone. Treatment resulted in conversion to sinus rhythm, but the patient again developed atrial fibrillation on postoperative day 5. During the morning hours of postoperative day 6, the patient experienced a peripheral i.v. line extravasation of amiodarone in his left arm. The amiodarone drip was discontinued, and amiodarone 400 mg orally twice daily was started. The nursing staff was instructed to treat the patient for the amiodarone extravasation with traditional nonpharmacologic measures, including warm compresses and elevation of the extremity. After extravasation, the patient reported severe pain at the site. Due to the patient's continued complaints of pain and the expanding area of induration, the interdisciplinary team elected to proceed with intradermal hyaluronidase. The patient reported significantly decreased pain and was discharged to inpatient rehabilitation on postoperative day 10 without any significant adverse effects.
Administration of intradermal hyaluronidase after amiodarone extravasation was associated with decreased expansion of erythema and warmth as well as an improvement in patient-reported pain scores without any noted adverse effects.
报告一例患者在经外周静脉输注胺碘酮时发生药物外渗，并接受皮内注射透明质酸酶治疗的病例。
一名60岁的白种男性在机动车碰撞后被送往急诊科。该患者被发现患有硬膜下血肿、多根肋骨骨折、胸骨体骨折、腹壁损伤、左锁骨骨折、右肱骨骨折和椎体骨折。他的病史包括高血压、心房颤动和中风，遗留右侧肢体无力。术后第1天，患者发生心房颤动，开始静脉输注胺碘酮。治疗后转为窦性心律，但患者在术后第5天再次发生心房颤动。在术后第6天上午，患者左臂外周静脉输注胺碘酮时发生药物外渗。胺碘酮静脉滴注停止，开始每日两次口服400mg胺碘酮。护理人员按照传统的非药物措施对患者进行胺碘酮外渗治疗，包括热敷和抬高患肢。外渗后，患者报告注射部位剧痛。由于患者持续诉说疼痛且硬结范围扩大，多学科团队决定采用皮内注射透明质酸酶治疗。患者报告疼痛明显减轻，并于术后第10天出院接受住院康复治疗，未出现任何明显不良反应。
胺碘酮外渗后皮内注射透明质酸酶可减少红斑和发热的范围，改善患者报告的疼痛评分，且未观察到任何不良反应。
