目的 系统综述与分析头孢唑林钠皮试阴性致过敏性休克的临床特点,以期为头孢唑林钠的安全合理应用提供依据。方法 计算机检索PUBMED、EMBASE、CBM、CNKI、VIP、WANFANG等数据库,时间截至2017年10月,纳入头孢唑林钠皮试阴性致过敏性休克的中英文病例报道,两位研究者独立文献筛选、数据提取及统计。结果 共检出文献1 358篇,最终纳入18篇。涉及患者20例,中位年龄39.0岁,60.0%患者无青霉素或药物过敏史,30.0%患者曾用过青霉素或头孢类抗菌药物,静脉滴注为主要给药途径。发生于30 min以内的速发型过敏性休克占47.6%,时间最长可发生在用药第7天,临床表现以循环系统损害为主,抢救措施包括立即停药、平卧、建立静脉通道、吸氧、给予血管活性药物和糖皮质激素等抗休克治疗,最终全部抢救成功。ADR关联性评价为肯定有关1例,很可能有关19例。结论 头孢唑林钠皮试阴性致过敏性休克需引起临床关注,青年、速发型过敏性休克比例高。以头孢唑林钠皮试结果预测过敏反应的价值有限,用药前掌握患者用药史和过敏史,重视全程用药监护,尤其用药30 min内,同时必须准备好过敏性休克的急救措施。
Abstract
OBJECTIVE To systematicly review and analyse the clinical characteristics of anaphylactic shock induced by cefazolin sodium with negative skin test, and provide a basis for the safe and reasonable application of cefazolin sodium. METHODS Databases of PUBMED, EMBASE, CBM, CNKI, VIP and WANFANG data(from built to October 2017)were conducted for case reports published in English or Chinese involving anaphylactic shock induced by cefazolin sodium. Literatures were screened, extracted and statistic analysed by two authors independently. RESULTS A total of 1 358 literatures were searched out and 18 were included involving 20 patients, the median age was 39.0 years, 60.0% of the patients had no history of penicillin or drug allergy, and 30.0% of the patients had used penicillin or cephalosporin antibiotics, and intravenous infusion was the main route of administration. Anaphylactic shock occurred within 30 min accouted for 47.6%, and the longest time occurred on the 7th day of medication. The clinical manifestations were mainly circulatory system damage, and the rescue measures included discontinuation of medicine immediately, prostration, establishment of intravenous channels, oxygen uptake, administration of vasoactive drugs and glucocorticoids, etc., all of which were eventually successfully rescued.The correlation evaluation of ADR was definite and probable in 1 and 19 cases, respectively. CONCLUSION High attention should be put on anaphylactic shock induced by cefazolin sodium with negative skin test. The proportion of young people and immediate anaphylactic shock were high.The cefazolin sodium skin test is of little value in predicting anaphylaxis. History of medication and allergies of patients should be taken in detail before medication, and the whole-process of medication, especially within 30 min should be closely monitored. Emergency rescue measures of anaphylactic shock should be prepared in advance.
关键词
头孢唑林钠 /
皮试阴性 /
过敏性休克 /
不良反应 /
系统分析
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Key words
cefazolin sodium /
negative skin test /
anaphylactic shock /
adverse drug reaction /
systematic retrospective study
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中图分类号：
R969.3
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