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重庆市2015－2022年药物过敏性休克救治使用肾上腺素情况的回顾性研究
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| 篇名： | 重庆市2015－2022年药物过敏性休克救治使用肾上腺素情况的回顾性研究 |
| TITLE： | Retrospective study on the use of epinephrine in patients with drug-induced anaphylactic shock in Chongqing from 2015 to 2022 |
| 摘要： | 目的 评价肾上腺素在药物过敏性休克救治中使用的合理性，为进一步规范过敏性休克的救治提供参考。方法依据重庆市药品不良反应（ADR）监测中心提供的2015－2022年药物过敏性休克严重ADR报告的相关数据，回顾性分析患者的救治药物选择及肾上腺素使用情况，探讨不同肾上腺素救治方案下过敏性休克患者的临床转归情况。结果共纳入1415份药物过敏性休克严重ADR报告，所涉患者男女比例为1.04∶1；引发过敏性休克的药物主要为抗感染药（47.92%）、中药注射剂（9.12%）；43.96%患者的ADR发生于用药后10min内；97.24%的患者治愈或好转，2.76%的患者死亡或未好转。1415例患者中，使用肾上腺素救治的占63.39%，首选肾上腺素救治的占53.14%；肌内注射、皮下注射、静脉注射和静脉滴注分别占33.78%、30.32%、25.75%和1.23%；肾上腺素的初始剂量范围为0.01～10mg，单次剂量以1mg居多（44.70%）；肌内注射、皮下注射和静脉注射单次剂量过量的分别有148例（51.03%）、136例（53.13%）和193例（91.47%），静脉注射给药更有可能出现单次剂量过量（P＜0.05）。初始救治使用肾上腺素者的好转/痊愈率显著高于非肾上腺素使用者（98.14%vs.96.23%，P＝0.029），首选肾上腺素者的好转/痊愈率显著高于非首选肾上腺素者（98.14%vs.95.17%，P＝0.031），肌内注射者的好转/痊愈率显著高于非肌内注射者（99.01%vs.96.69%，P＝0.038）。结论在药物过敏性休克的救治中，存在救治药物选择不适宜和肾上腺素使用不足、给药延迟、给药途径不适宜及单次剂量过高等不合理现象。 |
| ABSTRACT： | OBJECTIVE To evaluate the rationality of epinephrine in the treatment of drug-induced anaphylactic shock， and to provide a reference for further standardizing the treatment measures of anaphylactic shock. METHODS According to the relevant data of the reports of severe adverse drug reaction （ADR） of drug-induced anaphylactic shock provided by Chongqing ADR Monitoring Center from 2015 to 2022， the selection of treatment drugs， and the application of epinephrine in anaphylactic shock were analyzed retrospectively； the clinical outcomes of anaphylactic shock with different epinephrine administration methods were investigated. RESULTS A total of 1 415 cases of severe ADR related to drug-induced anaphylactic shock were reported， with a male-to-female ratio of 1.04∶1； the drugs that caused allergic shock mainly included anti-infective drugs （47.92%）， TCM injections （9.12%）； the patients who suffered from drug-induced anaphylactic shock within 10 min after medication accounted for 43.96%； 97.24% of patients were cured or improved， and 2.76% of patients died or did not been improved. Among 1 415 patients， 63.39% of patients were treated with epinephrine， and the patients who preferred epinephrine treatment accounted for 53.14%； the intramuscular injection， subcutaneous injection， intravenous injection and intravenous drip accounted for 33.78%， 30.32%， 25.75% and 1.23%， respectively. The initial dose range of epinephrine was 0.01-10 mg， and the most frequent single dose was 1 mg （44.70%）. Excessive single doses of intramuscular injection， subcutaneous injection and intravenous injection accounted for 51.03% （148 cases）， 53.13% （136 cases） and 91.47% （193 cases） respectively， and the risk of overdose in intravenous injection was higher （P＜0.05）. The patients receiving initial treatment with epinephrine had a higher improvement rate/cure rate than those who did not use epinephrine （98.14% vs. 96.23%， P＝0.029）； the patients who preferred epinephrine had a higher improvement rate/cure rate than those who did not preferred epinephrine （98.14% vs. 95.17%， P＝0.031）； the improvement rate/cure rate of patients receiving intramuscular injection of epinephrine was higher than those without intramuscular injection （99.01% vs. 96.69%， P＝0.038）. CONCLUSIONS There are some unreasonable phenomena in the treatment of drug-induced anaphylactic shock， such as inappropriate selection of drugs， insufficient use of epinephrine， delay of administration， inappropriate route of administration and excessive single dose. |
| 期刊： | 2023年第34卷第18期 |
| 作者： | 陈诚；王彦；邓莉；杜倩；刘松青；奚鑫 |
| AUTHORS： | CHEN Cheng，WANG Yan，DENG Li，DU Qian，LIU Songqing，XI Xin |
| 关键字： | 肾上腺素；药物过敏性休克；用药分析；不良反应 |
| KEYWORDS： | epinephrine； drug-induced anaphylactic shock； analysis of drug use； adverse drug reaction |
| 阅读数： | 50 次 |
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