可能是Trazodone引起的priapism？ 不知道下边什么药物可能有用。呵呵，你的患者都挺有特点。

Trazodone can enhance libido and in males, increase erectile function. Trazodone has been associated with the occurrence of priapism, likely due to its antagonism at α-adrenergic receptors. Priapism is a potentially harmful medical condition in which the erect penis does not return to its flaccid state (despite the absence of both physical and psychological stimulation) within four hours. In approximately 33% of the cases reported, surgical intervention was performed and, in a portion of these cases, permanent impairment of erectile function or impotence resulted. Medical advice should be sought immediately for cases of erection beyond four hours. Generally, this is done at an emergency department.

The first step in management is a blood exchange transfusion, not a surgical intervention. Orally administered pseudoephedrine may be effective, pseudoephedrine being an alpha-agonist, agent that exert a constriction effect on smooth muscle of corpora cavernosum, that in turn facilitate venous outflow.

Likewise, other sympathomimetic drugs of the amphetamine class have been observed to induce erectile dysfunction, although in a small number of cases they may have the opposite effect. Otherwise, the therapy at this stage is to aspirate blood from the corpus cavernosum under local anaesthetic. If this is still insufficient, then intracavernosal injections of phenylephrine are administered. This should only be performed by a specialist trained in the procedure, with the patient under constant hemodynamic monitoring, as phenylephrine can cause severe hypertension, bradycardia, tachycardia, and arrhythmia.

Terbutaline being a beta-2 agonist causes smooth muscle relaxation; in priapism it probably acts by relaxation of the stretched corporeal smooth muscles, or increasing permeability of erectile cavernous tissue permitting easy flow of fluid from sinusoids into the venous system. In priapism, it was suggested to be administered orally.

Methylene blue is used intracavernously to treat priapism, but it should not be used in treatment of recurrent priapism or fibrosis because it can induce penile necrosis. Temporary blue discoloration of the penis is also of concern.

 

If aspiration fails and tumescence recurs, surgical shunts are next attempted. These attempt to reverse the priapic state by shunting blood from the rigid corpora cavernosa into the corpus spongiosum (which contains the glans and the urethra). Distal shunts are the first step, followed by more proximal shunts.