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葛根素是从豆科植物野葛或甘葛藤干燥根中提出的一种异黄酮类化合物,其注射液用于心脑血管疾病的治疗。近年来葛根素注射液引起急性血管内溶血的报道增多,经检索国内相关文献,自1993年至2005年间应用葛根素注射液引起血管内溶血的患者共32例,男21例,女11例,平均年龄(69±9)岁;其中有10例死亡,平均年龄为(72±5)岁。在资料完整的25例患者中,21例单用葛根素注射液,4例为联合用药;葛根素100～700mg溶于0.9%氯化钠或5%葡萄糖注射液中静脉滴注;用药时间22例为5～10d,3例>10d。血管内溶血的临床表现主要为腰、背痛,血尿、尿少、血红蛋白尿,网织红细胞升高(0.05～0.30),高胆红素血症(29.1～123.2μmol/L)。22例患者经停药并给予糖皮质激素或抗组胺药物以及血液透析治疗后,多于6～7d症状消失或病情稳定。葛根素注射液致血管内溶血的可能因素为葛根素注射液的质量、患者过敏体质、年龄、用药时间或联合用药等。其发生机制可能与葛根素注射液引起的免疫性或非免疫性反应及其促氧化作用等有关。预防措施为:有过敏史者不宜应用;高龄及肝肾功能不全者用药应调整剂量;与可能致溶血的药物联用应谨慎。
Puerarin is a kind of isoflavonoids put forward from the dry roots of kudzu or kudzu vine in leguminous plants. Its injection is used in the treatment of cardiovascular and cerebrovascular diseases. In recent years, puerarin injection caused more reports of acute intravascular hemolysis, the retrieval of domestic literature, from 1993 to 2005 the application of puerarin injection of intravascular hemolysis in a total of 32 patients, 21 males and 11 females, The mean age was (69 ± 9) years old; 10 of them died, with an average age of (72 ± 5) years. Among the 25 patients with complete data, 21 cases were treated with puerarin alone and 4 cases were combined with puerarin. Puerarin 100 ~ 700mg was dissolved in 0.9% sodium chloride or 5% glucose injection by intravenous infusion. The medication time was 22 Cases for 5 ~ 10d, 3 cases> 10d. The main clinical manifestations of intravascular hemolysis were lumbar, back pain, hematuria, oliguria, hemoglobinuria, reticulocyte elevation (0.05-0.30) and hyperbilirubinemia (29.1-123.2 μmol / L). Twenty-two patients discontinued and were given glucocorticoid or antihistamine drugs and hemodialysis treatment, more than 6 ~ 7d disappeared or stable condition. Puerarin injection caused by intravascular hemolysis may be the factors of puerarin injection quality, patient allergy, age, medication time or combination of drugs. Its mechanism may be caused by puerarin injection of immune or non-immune reaction and its pro-oxidative effects and so on. Precautionary measures: allergic history should not be applied; elderly and liver dysfunction medication should be adjusted dose; and may lead to hemolysis drugs should be cautious.