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1995年我院曾遇到1例因作破伤风抗毒素试验发生过敏性休克的患儿。现报告如下。 1 病例介绍 患儿男,4岁,因面部跌伤来注射室作破抗试验。门诊护士取含1500u/1ml,在患儿前臂内侧皮内注射0.1ml(内含15n破抗)。注射12分钟后,患儿表现哭闹不安,注射局部出现风团样荨麻疹。以后,患儿全身出现荨麻疹,面色苍白,出冷汗,口唇及四肢末梢紫绀,脉细弱、神志不清,遵医嘱,立即给患儿皮下注射肾上腺素1/3支、吸氧,并于静脉推注50％葡萄糖20ml加地塞米松5mg,5分钟后,休克症状稍有好转,又用10％葡萄糖300ml加地塞米松5mg及洛贝林静滴。20分钟后,患儿清醒,逐渐恢复正常。 2 讨论 本例患儿是作破抗皮试12分钟后发生过敏性休克的,由于及时采取措施,使患儿转危为安。通过这一教训,我们认为今后在作破抗试验时,应注意以下几点。 作皮试前,应询问患者有无药物过敏史;给患者作试验后,嘱患者不要离开注射室,并密切观察局部及全身情况;试验结果判断为阴性的患者也应察5分钟才可离开,以防迟缓反应的发生;注射室应备有急救用药,氧气及器械,以利及时抢救。
In 1995, we had a case of anaphylactic shock in our hospital due to tetanus antitoxin test. The report is as follows. 1 case description Children, male, 4 years old, due to facial fall injury to the injection chamber for breaking resistance test. Outpatient nurses to take 1500u / 1ml, intradermal injection in the forearm in children 0.1ml (containing 15n broken anti). 12 minutes after injection, the performance of children crying uneasy, injection-like wind-like urticaria. Later, the children appeared urticaria body, pale, sweat, lips and extremities cyanosis, weak pulse, unconsciousness, as directed by the doctor immediately subcutaneous injection of adrenaline 1/3, oxygen, and in the vein 50% dexamethasone 50mg bolus 50ml dexamethasone 5mg, 5 minutes later, a slight improvement in shock symptoms, but also with 10% dexamethasone 300ml dexamethasone 5mg and intravenous Luo Bei Lin. After 20 minutes, children awake, gradually returned to normal. 2 Discussion This case of children is to break the skin test 12 minutes after anaphylactic shock occurred, due to timely measures to make the child safe. Through this lesson, we think the following points should be paid attention to in the future when it comes to breaking resistance tests. Before making a skin test, the patient should be asked whether there is a history of drug allergy. After giving the patient a test, he or she should not leave the injection room and observe the local and systemic conditions closely. The patient whose test result is negative should also observe for 5 minutes before leaving , To prevent the occurrence of slow response; injection room should be equipped with first aid medication, oxygen and equipment to facilitate timely rescue.