121例皮试阴性后使用头孢类注射剂致过敏性休克的文献分析  

Literature Analysis of 121 Cases of Anaphylactic Shock Induced by Cephalosporin Injection with Negative Skin Test

作　　者：姚晓英[1] 孟现民[1] 

机构地区：[1]上海市公共卫生临床中心,上海201508

出　　处：《中国药物警戒》2015年第6期352-356,共5页Chinese Journal of Pharmacovigilance

摘　　要：目的了解皮试阴性后使用头孢类注射剂致过敏性休克的发生特点及相关因素,为临床合理用药提供参考。方法检索、筛选国内期刊近10年报道的皮试阴性后应用头孢类注射剂致过敏性休克的文献报道,从患者年龄、性别、原患疾病、过敏史、皮试信息、所用药物、给药途径、溶媒、过敏性休克的发生时间、临床表现及转归等进行整理分析。结果共总结121例皮试阴性后使用头孢类注射剂发生过敏性休克的患者,其中以青年(45.45%)、老年(19.01%)最常见,75.21%的患者无药物过敏史,过敏史不详者为15.70%。使用头孢原药稀释后皮试的患者比例为90.91%,9.09%的患者使用青霉素或头孢唑林进行皮试。药物品种以三代头孢最为常见,部分患者存在单次用药剂量过大的问题。速发型过敏性休克的比例为81.82%,出现在输液开始后30 min内的比例达72.73%,迟发型过敏性休克的比例为18.2%。临床症状以呼吸、循环、中枢三大系统的表现为主,总死亡率为10.74%。结论头孢类药物的使用和皮试需进一步规范;即使皮试结果为阴性,在使用头孢类注射剂时仍应做到严密监护,以保证用药安全。Objective To understand the characteristics and relevant factors of anaphyhctic shock induced by cephalosporin injection with negative skin test, in order to provide a reference for safe medication in clinic. Methods The case reports of anaphylactic shock induced by cephalosporin with negative skin test, reported in domestic medical journal in the last ten years, were searched and filtered. Patient＇s age, gender, primary diseases, allergic history, skin test, drug use, routes of administration, selection of solvent, time of occurrence of anaphylactic shock, and clinical manifestations, were collected and analyzed. Results 121 cases with anaphylactic shock were collected, of which the youth was the most common （45.45%）, followed by the old （19.01%）. 75.21% of the cases had no drug allergic history, 15.70% unclear. 90.91% of skin tests were done using diluted cephalosporin, and 9.09% using penicillin or cefazolin. The most common drugs leading to anaphylactic shock were the third generation cephalosporin. There were also problems in the medication of patients, for example single drug dosages for some patients were too large. The percentage of patient with immediate anaphylactic shock was 81.82%, while 18.2% with delayed anaphylactic shock. 72.73% anaphylactic shock occurred within 30 rain after administration. Clinical symptoms mainly involved respiratory system, circulation system and central nervous system. The total mortality was 10.74%. Conclusion The use of cephalosporin and skin test need to be further standardized in China. Patients treated with cephalosporin need to be monitored closely, even if the skin test results are negative, so as to ensure the safety of drug use.

关 键 词：过敏性休克 头孢类药物 皮试阴性 文献分析 

分 类 号：R965[医药卫生—药理学]