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头孢吡肟致婴儿过敏性休克1例的急救护理

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・498・ 实用医药杂志2007年04月第24卷第04期Prae J Med&F'harm.Vol 24,2007—04 No.04 16 Wozakowska~Kaplon B.Effect of sinus rhythm restoration on Invest,2000,60(2):8 1 6 Ruskoaho H.Atrial natriuretic peptide:synthesis.release.and plasma brain natriuretic peptide in patients with atl il fiabrilla- metabolism.PharmacoJ Rev。I 992,44(4):479 7 Mit・TS,Marohn S,Lael’S,et a1.PIasma concentrations of N- lion.Am J Cardiol,2004,93(1 2):l 555 l 7 Ohta Y.Shimada T,Yoshitomi H,et a1.Drop in plasma brain natriuretic peptide levels after successful direct current cardio—- terminal pro-brain natriuretic peptide in control children from the neonatal to adolescent period and in children with congestive version in chronic atrial fibrillation.Can J Cardiol,200l,l7(4): 4l5 heart failure.Pediatrics,2002,l 10(6):e76 8 de Bold AJ,Bruneau BG,Kuroski de Bold ML.Mechanical antl neuroendocrine regulation of the endocrine hean.Cardiovasc Res. l 8 Beck—da-Silva Lde BA,Fraser M,el a1.Brain nalriuretic peptide predicts successful cardioversion in patients with atrial fibrilla— 1996,3l(1):7 9 Rashidi A.Mechanism of high brain natriuretic peptMe in patients tion and maintenance of sinus rhythm.Can J Cardio1.2004。20 (12):l245 19 Wazni OM,Mm'tin DO,Marrouche NF.et a1.Plasma B-type with atrial fibrillation.Am J Cal・diol,2004,93(5):670 1 0 Silvet H.Young-Xu Y,Walle,igh D,et a1.Brain natriuretie peptide nalriurelic peptide levels predict postoperative atril faibrillation in patients undergoing cardiac surgery.Circulation,2004,1 1 0 is elevated in outpatients with atrial fibrillation.Am J Cardiol, 2003,92(9):1 l24 (2):124 20 Takahashi Y,Yoshito 1,Takahashi A,et a1.AV nodal ablation and pacemaker implantation improves hemodynamic function in 1 1 W0zak0wska—Kapl0n B.Effect of sinus rhythm restoration on plasma brain natriuretlc peptide in patients with atrial fibrilla— tion.Am J Cardiol,2004,93(12):1555 l 2 Inoue S,Murakami Y,Sano K,et a1.Atrium as a source of brain atril faibrillation.Pacing Clin Eleetrophysio1.2003,26(5):1 2 l 2 2 l Horie H,Tsutamoto T,Minai K,et a1.Brain natriuretie peptide predicts chronic atrial fibrillation after ventricular pacing in natriuretic polypeptide in patients with ahial fibrillationJ Card Fail,2000,6(2):92 1 3 Tuinenburg AE,Brundel BJ,Van GI,et a1.Gene expression of the natt iuretlc peptide system in atrial tissue of patients with patients with sick sinus syndrome.Jpn Circ J,2000,64(12):965 22 Igarashi Y.Kashimura K。Makiyama Y,et a1.kfI atrial appendage dysfunction in chronic nonvalvular atrial fibrillation is signii— fparoxysmal and persistent atrial fibrillationJ Cardiovasc Elec— cantly associated with an elevated level of brain nat]iuretic trophysiol,1 999,1 0(6):827 1 4 Tsuchida K,Tanabe K.Influence of paroxysmal atrial fibrillation peptide and a prothrombotic state.Jpn Circ J,2001,65(9):788 23 Shimizu H,Murakami Y,lnoue S,et a1.High plasma brain natriu- retic polypeptide level as a marker of risk for thromboembolism in patients with nonvalvular atrial fibrillation.Stroke,2002,33 attack on brain natriuretic peptide secretion.J Cardiol,2004, 44(1):1 15 Vinch CS,Rashkin J,Logsetty G,et a1.Brain natriuretic peptide levels fall rapidly after eardioversion of atril faibrillation to sinus (4):l005 【收稿13期:2006—09—14】 【水文编辑:韩仲琪 rhythm.Cardiology,2004,102(4):188 急救措施处理。5:30患者精神差,呼吸逐渐平稳,皮疹渐淡, 个案与短篇 头孢吡肟 停止抽搐.rr 36.6℃,HR 140次/min,R 60次/airn。继续补液 纠酸.护脑及抗感染(磷霉素钠、ot一细辛脑)等治疗,住院9d 治愈出院。 急救护理:立即停用头孢毗肟,患者取平卧位,头偏向一 致婴儿过敏性休克1例的急救护理 吴之宇程山姿 侧.清除呼吸道分泌物,注意保暖。立即静脉注射0.1%盐酸 肾上腺素0.33mg、地塞米松2rag。随时观察用药效果。保持呼 (天门市第一人民医院,湖北天门 43l700) 【中图分类号】R978.1 1 l文献标识码J B 吸道通畅,立即吸痰.吸痰时选择规格合适硅胶吸痰管,操作 时注意动作轻柔,边吸边退边旋转,防止损伤呼吸道黏膜。给 予氧气吸入.改善呼吸困难及脑缺氧,氧流量0.6L/min,观察 患者女,41d,体重6kg。咳嗽气喘3d于2006—03—02—2: o0急诊人院。T 36.7℃,HR 146次/min,R 65次/min,精神 差.呼吸稍急促,双肺呼吸音粗.可闻及fitt/l'水泡音。实验室 给氧效果并记录。保持病室安静.抽搐时立即用10%水合氯 醛保留灌肠。密切观察患者意识、瞳孔、呼吸、心率、体温及抽 搐情况.不断评估治疗及护理效果并及时记录。继续观察药 物不良反应.防止再次发生过敏反应。 检查:白细胞4.9xlO L,淋巴细胞O.563,中性粒细胞0.330。 入院诊断婴儿肺炎。予以补液抗炎( 一细辛脑、头孢吡肟),对 临床上头孢菌素类过敏性休克较少见,小婴儿发生本症 极为罕见。该患者有青霉素过敏家族史,在接受头孢吡肟 症支持(氨茶碱、能量合剂)等治疗。用药前常规询问过敏史, 先锋霉素皮肤过敏试验阴性反应。患者于5:10静脉滴注头 孢毗肟40rain时.突然哭闹不安.继玎玎呼吸困难,口唇及面色 40min时才出现过敏反应,去甲肾上腺素急救一次后症状逐 渐缓解,预后良好。头孢菌素类与青霉素呈现不完企的交叉 过敏反应.对头孢菌素过敏者绝大多数对青霉素过敏。所以, 该患者不仅不能再次接受头孢菌素类药物,斫且须慎用或不 用青霉素类药物。 J收稿日期:2006—09一l 8】 J水义编辑:工宣l 发绀.手足皮肤湿冷.呈抽搐状,双手握拳,双眼凝视,四肢抽 动.喉头水肿.分泌物较多,双肺布满痰呜音及哮呜音,胸前 区及大腿内侧根部皮肤可见散在红色斑疹。R 80次/min. HR 186次/min,律齐无杂音.腹部平软,肝脾无肿大,考虑药 物过敏性休克。立即停药.首选去甲肾上腺素.按过敏性休克 

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