围术期头孢呋辛致过敏性休克的回顾性研究  

Retrospective analysis of perioperative anaphylactic shock induced by cefuroxime

作　　者：陈美芳[1] 张济帆 任晓蕾[2] 刘一[2] 黄琳[2] Chen Meifang;Zhang Jifan;Ren Xiaolei;Liu Yi;Huang Lin(Department of Infectious Disease,Peking University People′s Hospital,Beijing 100044,China;Department of Pharmacy,Peking University People′s Hospital,Beijing 100044,China;Department of Pharmacy,Tongliao Hospital,Tongliao 028000,China)

机构地区：[1]北京大学人民医院感染科,北京100044 [2]北京大学人民医院药学部,北京100044 [3]通辽市医院药剂科,通辽028000

出　　处：《中华内科杂志》2024年第4期406-411,共6页Chinese Journal of Internal Medicine

基　　金：白求恩求索-药学科研能力建设项目(B-19-H-20200622)。

摘　　要：探讨围术期头孢呋辛致过敏性休克的临床特点, 为围术期安全、合理使用头孢呋辛提供参考。调取2011—2021年北京大学人民医院药品不良反应监测系统中围术期头孢呋辛致过敏性休克的病例, 同时在中国知网(CNKI)、维普(VIP)、万方、PubMed和Web of Science数据库中, 检索建库至2022年5月31日关于围术期头孢呋辛致过敏性休克的相关文献, 并进行汇总分析。共计纳入患者31例, 包括北京大学人民医院2011—2021年围术期头孢呋辛致过敏性休克的病例12例, 检索数据库共获得相关文献16篇(涉及19例患者)。4例患者性别和年龄情况不详, 其余27例患者中有男性13例(48.1%), 女性14例(51.9%), 年龄以60岁以上居多(16例, 59.3%)。在所有的31例患者中, 9例患者(29.0%)有药物过敏史;5例患者(16.1%)在用药前进行了皮试且结果均为阴性;28例(90.3%)为静脉滴注给药, 给药剂量有所不同;22例患者(71.0%)在麻醉用药后发生过敏性休克, 其中20例(64.5%)发生在麻醉后10 min内;主要临床表现有低血压、呼吸困难、皮疹、心动过速等。患者经停药和积极抢救后均好转, 无死亡病例。过敏史及皮试结果对头孢呋辛所致围术期过敏性休克的预示作用有限;在围术期应用头孢呋辛时应提高警惕, 给药期间需要密切监测患者生命体征, 做好过敏性休克抢救准备, 及时采取应对措施, 保障患者用药安全。This study investigated the characteristics and frequency of perioperative anaphylactic shock induced by cefuroxime,so as to provide a reference for the safe and rational use of cefuroxime in the perioperative period.Cases of perioperative anaphylactic shock caused by cefuroxime in our hospital from 2011 to 2021 were extracted from the Adverse Drug Reaction Monitoring System.Literature reporting adverse drug reactions(ADR)including cefuroxime-induced anaphylactic shock in perioperative settings was collected from the CNKI,VIP,Wanfang,PubMed,and Web of Science databases from their respective inception to May 2022.Statistical analysis was performed for all cases of cefuroxime-induced perioperative anaphylactic shock.A total of 31 patients were included[13 men(48.1%)and 14 women(51.9%)],most of whom were over 60 years old(n=16,59.3%);9(29.0%)patients had a history of drug allergy;5(16.1%)patients had received skin tests,but with negative results;28(90.3%)patients received treatment intravenously;22(71.0%)patients were treated after anesthesia.For 20(64.5%)patients the ADR occurred within 10 minutes after anesthesia.The main manifestations were hypotension,dyspnea,rash,and tachycardia.For all patients,symptoms resolved after withdrawal of the drug and active rescue,and there were no deaths.A history of allergy and skin test findings may have limitations in predicting perioperative anaphylactic shock caused by cefuroxime;greater vigilance should be exercised when using cefuroxime in the perioperative period.Close monitoring is recommended for patients undergoing treatment with cefuroxime.Rescue therapy should be administered for allergic shock,and suitable response measures must be taken in a timely manner to ensure the safety of patients.

关 键 词：头孢呋辛 围术期 过敏反应 

分 类 号：R969.3[医药卫生—药理学]