25例药物过敏性休克肾上腺素救治再评价
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摘要
目的:通过分析我院药品不良反应上报系统中过敏性休克的肾上腺素救治过程,以促进肾上腺素在抢救时的合理使用。方法:调取2004年5月1日–2018年10月31日所有过敏性休克的药品不良反应和相关病历资料,统计引起过敏性休克药品品种及数量,对抢救过程中使用肾上腺素的给药剂量、给药途径和给药后的不良反应进行统计分析。结果:共调取药物导致过敏性休克55例,其中有25例(45.5%)使用肾上腺素救治。在25例病例中,首选肾上腺素的有16例(64.0%);有6例两次使用肾上腺素,共给予肾上腺素31例次,其中肌注1例次(3.2%),皮下注射3例次(9.7%),静脉推注10例次(32.3%),静脉滴注17例次(54.8%);13例次(41.9%)给药剂量过大,静脉推注发生的给药剂量过大的次数最多,有8例次(25.8%)。给予肾上腺素后发生快速性心律失常的有2例,均为过量静脉推注肾上腺素后出现。结论:药物过敏性休克抢救时首选肌注肾上腺素比例较低,给药剂量过大容易造成心律失常并发症,需要进一步加强过敏性休克肾上腺素救治的临床培训和临床路径的管理。
Objective: To analyze the application of adrenaline in anaphylactic shock patients through the adverse reaction reporting system in our hospital, in order to promote the rational use of adrenaline. Methods: Data of all adverse drug reactions of anaphylactic shock from May 1st 2004 to October 31st 2018 were collected from the adverse reaction reporting system. Variety and quantity of drugs inducing anaphylactic shock, the dose and route of adrenaline, and the adverse reaction of adrenaline were statistically analyzed. Results: A total of 55 cases of anaphylactic shock were collected, among which 25 cases(45.5%) were treated with adrenaline. Of the 25 cases, adrenaline was the first choice in 16 cases(64.0%). Adrenaline was given twice in 6 cases with a total of 31 times including 1 time of intramuscular injection(3.2%), 3 times of subcutaneous injection(9.7%), 10 times of intravenous injection(32.3%), 17 times of intravenous infusion(54.8%), 13 times(41.9%) of overdose. And overdose adrenaline was mostly used with intravenous injection, which was accounted for 25.8% of 31 times(8 times). 2 cases developed tachyarrhythmia after intravenous injection of overdose adrenaline. Conclusion: Proportion of taking intramuscular injection of adrenaline as the first choice in the rescue of anaphylactic shock was relatively low. Overdose of adrenaline could cause arrhythmia. Therefore, it is necessary to further strengthen the management of clinical training and clinical pathway for the treatment of anaphylactic shock with adrenaline.
Objective: To analyze the application of adrenaline in anaphylactic shock patients through the adverse reaction reporting system in our hospital, in order to promote the rational use of adrenaline. Methods: Data of all adverse drug reactions of anaphylactic shock from May 1st 2004 to October 31st 2018 were collected from the adverse reaction reporting system. Variety and quantity of drugs inducing anaphylactic shock, the dose and route of adrenaline, and the adverse reaction of adrenaline were statistically analyzed. Results: A total of 55 cases of anaphylactic shock were collected, among which 25 cases(45.5%) were treated with adrenaline. Of the 25 cases, adrenaline was the first choice in 16 cases(64.0%). Adrenaline was given twice in 6 cases with a total of 31 times including 1 time of intramuscular injection(3.2%), 3 times of subcutaneous injection(9.7%), 10 times of intravenous injection(32.3%), 17 times of intravenous infusion(54.8%), 13 times(41.9%) of overdose. And overdose adrenaline was mostly used with intravenous injection, which was accounted for 25.8% of 31 times(8 times). 2 cases developed tachyarrhythmia after intravenous injection of overdose adrenaline. Conclusion: Proportion of taking intramuscular injection of adrenaline as the first choice in the rescue of anaphylactic shock was relatively low. Overdose of adrenaline could cause arrhythmia. Therefore, it is necessary to further strengthen the management of clinical training and clinical pathway for the treatment of anaphylactic shock with adrenaline.
引文
[1]Kemp SF, Lockey RF, Simons FE. Epinephrine:the drug of choice for anaphylaxis-a statement of the world allergy organization[J].World Allergy Organ J, 2008, 1(7 Suppl):S18-S26.
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[3]Droste J, Narayan N. Hospital doctors'knowledge of adrenaline(epinephrine)administration in anaphylaxis in adults is deficient[J].Resuscitation, 2010, 81(8):1057-1058.
[4]Muraro A, Roberts G, Worm M, et al. Anaphylaxis:guidelines from the European Academy of Allergy and Clinical Immunology[J].Allergy, 2014, 69(8):1026-1045.
[5]Goodall N. Guideline review:epinephrine use in anaphylaxis(AAP guideline 2017)[J]. Arch Dis Child Educ Pract Ed, 2018,doi:10.1136/archdischild-2017-314592.
[6]任晓蕾,詹轶秋,张春燕,等.45例药源性过敏性休克病例分析[J].医药导报,2018,37(6):366-368.
[7]Stiefel G, Anagnostou K, Boyle RJ, et al. BSACI guideline for the diagnosis and management of peanut and tree nut allergy[J]. Clin Exp Allergy, 2017, 47(6):719-739.
[8]Simons FE. Pharmacologic treatment of anaphylaxis:can the evidence base be strengthened[J]. Curr Opin Allergy Clin Immunol,2010, 10(4):384-393.
[9]Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in anaphylaxis:higher risk of cardiovascular complicationsand overdoseafteradministrationofintravenousbolus epinephrinecompared with intramuscular epinephrine[J]. J Allergy Clin Immunol Pract, 2015, 3(1):76-80.
[2]Sicherer SH, Simons FER. Epinephrine for first-aid management of anaphylaxis[J]. Pediatrics, 2007, 119(3):638-646.
[3]Droste J, Narayan N. Hospital doctors'knowledge of adrenaline(epinephrine)administration in anaphylaxis in adults is deficient[J].Resuscitation, 2010, 81(8):1057-1058.
[4]Muraro A, Roberts G, Worm M, et al. Anaphylaxis:guidelines from the European Academy of Allergy and Clinical Immunology[J].Allergy, 2014, 69(8):1026-1045.
[5]Goodall N. Guideline review:epinephrine use in anaphylaxis(AAP guideline 2017)[J]. Arch Dis Child Educ Pract Ed, 2018,doi:10.1136/archdischild-2017-314592.
[6]任晓蕾,詹轶秋,张春燕,等.45例药源性过敏性休克病例分析[J].医药导报,2018,37(6):366-368.
[7]Stiefel G, Anagnostou K, Boyle RJ, et al. BSACI guideline for the diagnosis and management of peanut and tree nut allergy[J]. Clin Exp Allergy, 2017, 47(6):719-739.
[8]Simons FE. Pharmacologic treatment of anaphylaxis:can the evidence base be strengthened[J]. Curr Opin Allergy Clin Immunol,2010, 10(4):384-393.
[9]Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in anaphylaxis:higher risk of cardiovascular complicationsand overdoseafteradministrationofintravenousbolus epinephrinecompared with intramuscular epinephrine[J]. J Allergy Clin Immunol Pract, 2015, 3(1):76-80.