Prieto Alvarez M P, Fuentes Bellido J G, López Cebollada J, Escoda Teigell L, Lorenzo Foz J P
Servicio de Anestesiología, Reanimación y Clínica del Dolor, Pius Hospital de Valls, Tarragona.
Rev Esp Anestesiol Reanim. 1998 Jun-Jul;45(6):248-50.
Agranulocytosis induced by metamizole is uncommon, with a frequency of less than one case per million treatments. We describe such a case in a patient requiring emergency surgery. An 85-year-old man with a history of infantile paralysis with mental retardation and Paget's disease and X-ray signs of the right femur came to the emergency room with a diaphysial fracture. He received 1 g metamizole i.v. every 8 hours for analgesia. Ten hours after admission a routine blood cell count showed a rapid fall in the number of leukocytes; at 24 hours the count was 600 x 10(9)/l. The diagnosis was agranulocytosis induced by metamizole. Postponement of surgery was advisable and treatment with granulocyte colony stimulating factor (GCSF) at a dose of 5 micrograms/kg/day. Agranulocytosis resolved after 3 days of treatment, after which time the bone was set with a straight femoral plate under subarachnoid anesthesia. Two packs of red blood cells were required during the immediate postoperative period. Twelve days after surgery the patient was released. We review the anesthetic approach to agranulocytosis and its treatment.
安乃近引起的粒细胞缺乏症并不常见，发生率低于每百万次治疗一例。我们描述了一例需要紧急手术的患者的此类病例。一名85岁男性，有小儿麻痹症伴智力发育迟缓、佩吉特病病史及右股骨X线征象，因骨干骨折来到急诊室。他每8小时静脉注射1克安乃近用于镇痛。入院10小时后常规血细胞计数显示白细胞数量迅速下降；24小时时计数为600×10⁹/L。诊断为安乃近引起的粒细胞缺乏症。建议推迟手术，并以5微克/千克/天的剂量用粒细胞集落刺激因子（GCSF）进行治疗。治疗3天后粒细胞缺乏症得到缓解，之后在蛛网膜下腔麻醉下用直型股骨钢板固定骨头。术后即刻需要两单位红细胞。术后12天患者出院。我们回顾了粒细胞缺乏症的麻醉处理方法及其治疗。
