低分子右旋糖酐氨基酸注射液致过敏性休克的危险因素分析  

Risk Factors of Anaphylactic Shock Caused by Dextran 40 and Amino Acid Injection

作　　者：夏红霞 张雅稚 王芳 王玲 Xia Hongxia;Zhang Yazhi;Wang Fang;Wang Ling(Department of General Surgery,Xiangyang Central Hospital,Hospital Affiliated of Hubei University of Arts and Sciences,Xiangyang 441021 ,Hubei,China;Department of Pharmacy,Xiangyang Central Hospital,Hospital Affiliated of Hubei University of Arts and Sciences,Xiangyang 441021 ,Hubei,China)

机构地区：[1]湖北文理学院附属医院襄阳市中心医院普外科,湖北襄阳441021 [2]湖北文理学院附属医院襄阳市中心医院药学部,湖北襄阳441021

出　　处：《药物流行病学杂志》2019年第3期163-166,共4页Chinese Journal of Pharmacoepidemiology

摘　　要：目的:探讨低分子右旋糖酐氨基酸注射液致过敏性休克(AS)的危险因素,为临床安全用药提供参考。方法:收集2010年1月～2018年11月我院上报的278例低分子右旋糖酐氨基酸注射液致不良反应(ADR)个案报告,按照AS诊断标准分为AS组(45例)和非AS组(233例),采用单因素(χ~2检验)及多因素(Logistic回归)分析法对患者年龄、性别、过敏史、血清总蛋白水平、手术治疗、肾功能、肝功能、原患疾病、日用剂量、累积用药时间和联合用药等相关因素进行分析。结果:278例低分子右旋糖酐氨基酸注射液的ADR病例中发生AS 45例,构成比为16.19%。单因素分析显示,患者年龄、血清总蛋白水平、手术治疗、血清肌酐清除率、累积用药时间与AS相关。多因素分析显示,累积用药时间较长(>5 d)、低蛋白血症(<60 g·L^(-1))、老龄(≥65岁)、肌酐清除率低(≤30 ml·min^(-1))和手术治疗是低分子右旋糖酐氨基酸注射液致AS的独立危险因素,其OR值分别为2.68,2.39,2.12,2.02和1.89。45例AS患者经停药,予以肾上腺素、地塞米松、异丙嗪等,同时及时予以吸氧、补液等干预措施,最后44例痊愈出院,1例死亡。结论:临床实践中应重点关注有AS危险因素的患者,以保证低分子右旋糖酐氨基酸注射液的临床安全用药,减少AS发生率。Objective:To investigate risk factors of anaphylactic shock(AS) caused by dextran 40 and amino acid injection, to provide a reference for clinical safety medication. Methods:Among 278 cases of adverse drug reaction(ADR) induced by Dextran 40 and Amino Acid Injection were collected from our hospital from January of 2010 to November of 2018, which divided into AS group(45 cases) and non-AS group(233 cases) according to AS diagnostic criteria. Relevant factors such as age, gender, allergic history, serum total protein level, surgical treatment, renal function, liver function, primary disease, daily dose, cumulative medication time, and combination medication were analyzed by univariate(χ^2 test) and multiple factors(Logistic regression). Results:AS was one of the serious ADR of dextran 40 and amino acid injection, it’s incidence was 16.19% in this investigation. Univariate analysis showed that the patient’s age, serum total protein levels, perioperative period, serum creatinine clearance, medication with AS. And multiple factors analysis showed that prolong administration(>5 d), hypoproteinemia(<60 g·L^-1), aging(≥65 years), renal insufficiency(≤30 ml·min^-1) and surgical treatment were independent risk factors of AS, and the OR values respectively were 2.68, 2.39, 2.12, 2.02 and 1.89. The 45 cases of AS patients were stopped drug, and given epinephrine, dexamethasone, promethazine and so on, meanwhile given timely interventions such as oxygen intake and rehydration, at last the 44 patients were cured and discharged. One patient died and 2.22% of patients with AS. Conclusion:Clinical practice should focus on patients with independent risk factors to ensure clinical safe use of dextran 40 and amino acidinjection.

关 键 词：低分子右旋糖酐氨基酸注射液 药品不良反应 过敏性休克 危险因素 

分 类 号：R977.8[医药卫生—药品]