Zespół Nicolaua to rzadko występujące niepożądane działanie leku podanego domięśniowo. Spowodowane jest niezamierzonym przedostaniem się substancji do światła tętnicy. W skrajnych przypadkach rozwijająca się w schorzeniu martwica obejmuje całą stopę lub podudzie, co może prowadzić do konieczności amputacji kończyny.
Zespół Nicolaua może być następstwem nieprawidłowego podania leków, najczęściej domięśniowych w pośladek, rzadziej dożylnych, podskórnych czy dostawowych. Syndrom rozwija się m.in na skutek zbyt szybkiego podania preparatu, ze zbyt wysokim ciśnieniem lub wstrzyknięcia substancji w to samo miejsce kolejny raz. Przyczyną rozwoju schorzenia może być także zbyt wysoka objętość leku czy wielkość kryształków podawanego preparatu.
W jaki sposób objawia się zespół Nicolaua?
Objawy kliniczne zespołu Nicolaua mogą rozwinąć się po upływie kilku minut lub godzin od podania leku. Pierwszym objawem jest najczęściej silny ból, który występuje w czasie podawania leku lub bezpośrednio po zakończeniu jego podawania. Lżejsze przypadki charakteryzują się odczuwaniem jedynie nadwrażliwości na dotyk w miejscu iniekcji.
Często syndrom Nicolaua manifestuje się brakiem tętna w tętnicach obwodowych bez spadku ciśnienia tętniczego. U pacjentów dochodzi do niedokrwienia, a na skórze występują przebarwienia i sinoczerwone plamy, niekiedy o charakterze sinicy groniastej. Obserwowane są również zmiany skórne w postaci odgraniczonej bladości skóry w miejscu iniekcji, która może objąć oba pośladki, skórę podbrzusza, a także obie kończyny dolne. W przebiegu schorzenia rozwija się także martwica tkanek, tkanek podskórnych lub mięśni. W skrajnych przypadkach obejmuje ona całą stopę lub podudzie. Martwica zazwyczaj goi się w przeciągu kilku miesięcy i może pozostawiać po sobie blizny zanikowe.
Objawom skórnym może towarzyszyć utrzymywanie się przez wiele dni krwawych stolców, a także niewydolność zwieraczy. Około 1/3 przypadków kończy się powikłaniami neurologicznymi, takimi jak niedoczulica czy porażenie. Postępująca martwica może doprowadzić do konieczności amputacji kończyny. Niewdrożenie leczenia może z koeli prowadzić do zgonu pacjenta.
Leczenie i zapobieganie zespołowi Nicolaua
W przypadku silnego bólu podczas podawania leku należy natychmiast przerwać iniekcję i szybko usunąć igłę z ciała pacjenta. Zbyt powolne podjęcie interwencji może grozić śmiercią.
Rozpoznanie zespołu Nicolaua przeprowadza się na podstawie wystąpienia charakterystycznych objawów oraz przeprowadzonych badaniach krwi. Nie ma opracowanej konkretnej strategii leczenia. W praktyce klinicznej zespół Nicolaua leczy się poprzez usuwanie zmian martwiczych, stosowanie leków przeciwbólowych oraz odpowiednich opatrunków i pielęgnację rany. Pacjentom zalecane są również leki zwiększające przepływ krwi oraz przeciwzakrzepowe, a także sterydowe. Niekiedy konieczne jest wdrożenie leków przeciwwstrząsowych.
Działania profilaktyczne w zapobieganiu wystąpienia zespołu Nicolaua polegają przede wszystkim na prawidłowym wykonaniu iniekcji. Należy pamiętać o dostosowaniu igły do masy ciała pacjenta oraz o podaniu odpowiedniej ilości leku, nie większej niż zalecana w ulotce i Charakterystyce Produktu Leczniczego.
Źródła: dermatologia-praktyczna.pl, forumkardiologiczne.pl, National Center for Biotechnology Information
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