青霉素类药物皮试阴性患者发生过敏反应的临床特征及危险因素分析  

Analysis of clinical features and risk factors of allergic reactions in patients with negative skin tests to penicillins

作　　者：孟佳 张静宇[2] 张婉 孙静 张媛媛 Meng Jia;Zhang Jingyu;Zhang Wan;Sun Jing;Zhang Yuanyuan(Department of Pharmacy,Hengshui People′s Hospital,Hengshui 053000,China;Department of Pharmacy,Hengshui Second People′s Hospital,Hengshui 053000,China;Department of Pharmacy,Hengshui Fourth People′s Hospital,Hengshui 053000,China;Department of Pharmacy,Hengshui Maternal and Child Health Hospital,Hengshui 053000,China)

机构地区：[1]衡水市人民医院药学部,河北衡水053000 [2]衡水市第二人民医院药剂科,河北衡水053000 [3]衡水市第四人民医院药剂科,河北衡水053000 [4]衡水市妇幼保健院药剂科,河北衡水053000

出　　处：《实用药物与临床》2023年第2期144-147,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨青霉素类药物皮试阴性患者发生过敏反应的临床特征及危险因素。方法筛选2017年1月至2022年5月衡水市4家医院ADR监测中心报告的青霉素类药物皮试阴性、用药期间发生的青霉素类药物致过敏反应的病例报道,按照患者性别与年龄、药品名称、用法用量、过敏反应发生时间、累及器官/系统及临床表现和转归等进行统计分析。结果共纳入121例患者,男女比例为1∶1.42;发生比例最高的年龄段为>65岁(55/121,45.45%);药品主要为阿莫西林克拉维酸钾、哌拉西林他唑巴坦钠和青霉素;给药途径以静脉滴注为主(114/121,94.21%);发生时间以用药第1天内最多(71/121,58.65%);主要表现为局部红斑或皮疹、瘙痒、胸闷气短、血压下降等。年龄(>65岁)、恶性肿瘤、慢性肾功能不全、低蛋白血症(<25 g/L)是青霉素类药物皮试阴性患者发生过敏反应的独立危险因素(P<0.05)。结论临床医师、护师和药师应全面掌握青霉素类药物皮试阴性患者发生过敏反应的特点,对合并高危因素的患者应予以高度警惕,提高过敏反应鉴别能力。Objective To explore the clinical features and risk factors of allergic reactions by penicillins in patients with negative skin test.Methods Case reports of allergic adverse reactions to penicillins in patients with negative skin tests were screened in ADR monitoring centers of 4 hospitals in Hengshui from January 2017 to May 2022.Statistical analysis was carried out based on the gender and age of the patients,the name of the drugs,usage and dosage,the time of allergic reaction,the involved organs/systems,clinical manifestations and outcomes.Results A total of 121 patients were included in this study.In these cases,the ratio of males to females was 1∶1.42.Most of the allergic reactions occurred among elderly patients who are over 60 years old(55/121,45.45%).The drugs mainly were amoxicillin-clavulanate potassium,piperacillin-tazobactam and penicillin.The main route of administration was intravenous drip(114/121,94.21%).Allergic reactions mainly occurred within 1 day of medication(71/121,58.65%).The main clinical manifestations were local erythema or rash,itching,chest tightness,shortness of breath,and decreased blood pressure.Age(>65 years old),malignant tumor,chronic renal insufficiency,and hypoalbuminemia(<25 g/L)were independent risk factors for allergic reactions in patients with negative penicillin skin test(P<0.05).Conclusion Clinicians,nurses and pharmacists should fully grasp the characteristics of allergic reactions in patients with negative penicillin skin tests,and should be highly alert to patients with high risk factors to improve the ability to identify allergic reactions.

关 键 词：青霉素类药物 皮试阴性 过敏反应 危险因素 

分 类 号：R969[医药卫生—药理学]