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抗生素治疗中的危重病人发生大出血,其原因可能是由于抗生素,也可能是潜在疾病的发展所致。使用抗生素引起出血的机理是:1)骨髓受抑制和骨髓再生障碍而致血小板减少;2)免疫性血小板破坏;3)周围血小板功能抑制;4)香豆定(Coumadin)作用增强;5)依赖维生素K的凝血机理破坏。骨髓抑制和再生障碍最常见于用氯霉素时。再生障碍是特异性的。可复性的抑制则与药物剂量有关,其特征为:1)血浆中的铁和结合铁的浓度增加;2)网织红细胞计数下降;3)周围血液中的组成成分下降。当肝脏有实质性病变时,接受大剂量(>25～30mg/kg/d)的氯霉素治疗或延长用药时间则更易引起出血。氯霉素的这种毒性被认为是由于抑制了骨髓线粒体上的蛋白合成所致。所以用氯霉素治疗时,观察病人的血细胞计数和白
Major bleeding in the treatment of critically ill patients with antibiotics, the reasons may be due to antibiotics, may also be due to the development of underlying diseases. The mechanisms by which antibiotics cause bleeding are: 1) thrombocytopenia caused by inhibition of bone marrow and bone marrow regeneration disorders; 2) immune destruction of platelets; 3) inhibition of peripheral platelet function; 4) enhanced action of Coumadin; 5) dependence The clotting mechanism of vitamin K is destroyed. Myelosuppression and aplastic disorders most commonly occur with chloramphenicol. Aplastic disorders are specific. Refolding inhibition is related to the dose of the drug and is characterized by: 1) an increase in the concentration of iron and bound iron in the plasma; 2) a decrease in reticulocyte count; and 3) a decrease in the composition of the surrounding blood. When the liver has substantial disease, receiving high doses (> 25 ~ 30mg / kg / d) of chloramphenicol treatment or prolonged medication is more likely to cause bleeding. This toxicity of chloramphenicol is thought to be due to inhibition of protein synthesis on the myeloid mitochondria. Therefore, when treated with chloramphenicol, observe the patient’s blood cell count and white