异位妊娠出血诱发DIC并发急性胰腺炎及 舒普深相关凝血功能恶化1例报告

Ectopic Pregnancy Hemorrhage-Induced Disseminated Intravascular Coagulation (DIC) Complicated by Acute Pancreatitis and Cefoperazone/Sulbactam-Related Coagulation Dysfunction: A Case Report

摘要: 本文报道一例异位妊娠破裂致失血性休克、弥散性血管内凝血(Disseminated Intravascular Coagulation, DIC)，继发急性胰腺炎(Acute Pancreatitis, AP)后，使用头孢哌酮/舒巴坦(舒普深)抗感染加重凝血功能障碍的病例。患者为45岁女性，术后因腹腔感染予舒普深治疗5天，出现血尿、消化道出血及凝血功能急剧恶化(PT 40.0 s, INR 1.73)，而纤维蛋白原及血小板呈回升趋势。排除其他因素后考虑为舒普深所致，停药并予维生素K1及新鲜冰冻血浆后凝血功能迅速改善。本病例提示，DIC继发AP的抗感染治疗中，需高度警惕舒普深叠加加重凝血功能障碍的风险，用药期间应严密监测凝血指标，一旦出现PT/APTT进行性延长而纤维蛋白原回升，应及时停药并干预。

Abstract: This article reports a case of exacerbated coagulation dysfunction following the use of cefoperazone/sulbactam for anti-infective therapy in a patient with hemorrhagic shock and Disseminated Intravascular Coagulation (DIC) secondary to ruptured ectopic pregnancy, subsequently complicated by Acute Pancreatitis (AP). A 45-year-old female received cefoperazone/sulbactam for intra-abdominal infection for 5 days postoperatively. She developed hematuria, gastrointestinal bleeding, and acute deterioration of coagulation function (PT 40.0 s, INR 1.73), while fibrinogen and platelet levels showed a recovery trend. After excluding other factors, this was attributed to cefoperazone/sulbactam. Coagulation function improved rapidly following drug discontinuation and administration of vitamin K1 and fresh frozen plasma. This case highlights that in anti-infective therapy for AP secondary to DIC, close attention should be paid to the risk of cefoperazone/sulbactam exacerbating coagulation dysfunction. During treatment, coagulation parameters must be closely monitored; if PT/APTT progressively prolong while fibrinogen recovers, the drug should be discontinued promptly and interventions initiated.