Octreotide用於先天性乳糜胸－案例報告與文獻回顧

Octreotide for Treating Congenital Chylothorax, Case Report and Literature Review

劉佳美(Jia-Mei Liou) ； 王春玉(Chun Yu Wang) ； 劉人瑋(Jen-Wei Liu)

《臺灣臨床藥學雜誌》 25卷3期 (2017/07) Pp. 269-274

https://doi.org/10.6168/FJCP.2017.2503.10

摘要

簡介：乳糜胸可能增加呼吸道相關死亡率、免疫功能低下與營養不良等嚴重後果，因此及早診斷及治療乳糜胸相當重要。治療方式主要分為手術、飲食及藥物控制。治療藥物octreotide 是somatostatin 的類似物，可用於治療乳糜胸。案例：本案例報告病人妊娠週數38 + 1 週，出生體重3,160 克。Apgar score 在出生1 及5 分鐘的分數分別為5 和7，因呼吸衰竭而轉入新生兒加護病房。由病人的臨床表現，醫師高度懷疑乳糜胸，經過octreotide 治療11 天即可移除胸管且未出現復發。討論：根據文獻回顧，octreotide 可用於治療先天性乳糜胸，最佳治療劑量及療程長短尚未有定論，有治療成功但乳糜胸復發的案例報告。Octreotide 有代謝異常、膽汁鬱積及形成膽結石的副作用，醫師及藥師使用octreotide 治療乳糜胸時，需注意可能的傷害。

關鍵字

兒童 ； 乳糜胸 ； Octreotide

並列摘要

Introduction: Chylothorax is a disease that will cause malnutrition and compromise immunity in infant and children. Current management of chylothorax include medication and surgical intervention. Octreotide is a somatostatin analogue that has been used to treat chylothorax in children. Case: A male newborn was born at gestational age 38 + 1 weeks, birth weight 3,160 gm, and Apgar score 5 turned to 7 at 1 and 5 minutes after birth. Patient was admitted to neonate intensive care unit because of respiratory failure. Chylothorax was highly suspected based on clinical presentation. Octreotide intravenous infusion was used for 11 days and chylothorax was successfully managed. Patient was discharged without chylothorax recurrence. Discussion: Octreotide had shown efficacy for treating congenital chylothorax in previous case report and systematic review. The optimal dose and treatment duration was not determined and several cases had recurrence after initial success. Octreotied had been reported to cause metabolic dysfunction, cholelithiasis and biliary stone. Pediatrician s and pharmacists should be aware of potential harm of octreotide when treating congential chylothorax.

並列關鍵字

Children ； Chylothorax ； Octreotide