42例住院患者严重过敏反应临床特点  

Clinical Characteristics of 42 Inpatients with Anaphylaxis

作　　者：汤蕊[1] 陈适[2] 刁颖[1] 孙劲旅[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院变态反应科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院内分泌科卫生计生委内分泌重点实验室,北京100730

出　　处：《中华临床免疫和变态反应杂志》2015年第4期278-282,共5页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的分析住院患者严重过敏反应的临床特点和影响因素。方法回顾性分析1990年至2013年住院患者中42例发生严重过敏反应的一般情况、血压心率变化、病因、基础疾病、临床表现及其影响因素。结果患者平均年龄(39±16)岁,男女比例为1∶2.2;发作时收缩压及舒张压均较基础血压明显下降[收缩压:(116.0±12.1)mm Hg vs.(51.0±35.4)mm Hg,舒张压:(75.6±9.3)mm Hg vs.(26.6±19.6)mm Hg],发作心率较基础心率明显增加[(84±12)次/min vs.(123±24)次/min],差异均有统计学意义(P<0.01)。引起严重过敏反应的最主要病因为药物(35/42),其中最常见为抗生素(14/35);严重过敏反应临床表现中以皮肤表现最常见(73.8%),其次为呼吸系统(59.5%)、神经系统(54.8%)和循环系统症状(52.4%),再次为消化系统症状(28.6%)。临床表现的影响因素中男性患者更易出现意识丧失(P=0.01),血压测不到的患者多出现意识丧失(P<0.05);多系统受累患者以男性常见(P<0.01),发作时血压更低(P<0.05),既往有过敏性疾病病史患者更常见(P<0.05),食物和造影剂引起过敏者多见(P<0.05)。治疗首选肾上腺素,死亡率较前明显下降。结论严重过敏反应发作时血压明显下降、心率明显增加;病因以药物诱发为主,最常见为抗生素;临床表现中以皮肤表现最常见;男性患者更易出现意识丧失;男性、发作血压更低、基础病为过敏反应疾病及食物和造影剂诱发者更易出现多系统受累。Objective To analyze the clinical characteristics and influence factors of the inpatients with anaphylaxis. Methods The general conditions,changes of blood pressure and heart rate,causative agents,underlying diseases,clinical manifestations and influence factors of 42 inpatients with anaphylaxis from 1990 to 2013 were analyzed retrospectively in this article. Results The average age of patients was 39 ± 16 years old. The male female ratio was 1∶ 2. 2. There were marked drops of systolic and diastolic blood pressure in attack stage [systolic blood pressure（ 116. 0 ± 12. 1） mm Hg vs.（ 51. 0 ± 35. 4） mm Hg,diastolic blood pressure（ 75. 6 ± 9. 3） mm Hg vs.（ 26. 6 ± 19. 6） mm Hg,and significant increasing in heart rate（ 84 ±12） beats / min vs.（ 123 ± 24） beats / min] compared to the base values respectively. The difference waspredominant statistically（ P 0. 01）. The most common cause was drugs（ 35 /42）,especially antibiotics（ 14 /35）. Clinical manifestations of anaphylaxis included cutaneous（ 73. 8%）,respiratory（ 59. 5%）,nervous（ 54. 8%）,circulatory（ 52. 4%） and digestive（ 28. 6%） symptoms. The male（ P = 0. 01） and patients with low blood pressure（ P 0. 05） were predisposed to loss of consciousness. Multi-system involving was more frequently occurred among male（ P 0. 01）,patients with low blood pressure（ P 0. 05）,allergic diseases（ P 0. 05） and food and contrast medium as causative agents（ P 0. 05）.Mortality would decline obviously if epinephrine was given as the first choice of treatment. Conclusions There were marked drops of blood pressure in attack stage and significant increasing in heart rate during anaphylaxis attacks. The most common cause was drugs,especially antibiotics. The cutaneous symptom was most common manifestation. The male patients were predisposed to loss of consciousness. Multi-system involving was more frequently occurred among male,patients with low blood pressure,allergic diseases and food and contrast medi

关 键 词：严重过敏反应 住院患者 临床特点 影响因素 

分 类 号：R593.1[医药卫生—内科学]