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患者男,75岁,因上腹痛,反酸 5年,头昏、乏力 2天,柏油样便1天就诊。入院时查 Hb 86g/L,WBC12.5×10~9/L,BpC120×10~9/L,RBC3.5×10~(12)/L。诊断为上消化道出血、失血性贫血(中度)。给予 5％葡萄糖注射 500ml+西咪替丁1.0g静滴。输液速度40滴/min,输入液体 10min,液体量约 26ml时突然出现干咳、全身大汗,呼气性呼吸困难,唇发绀,查体:P 130次/min,节律齐,R 30次/min,BP 97/60mmHg(13/8kPa),SaO_287％,双肺闻及哮鸣音,考虑为西咪替丁所致的支气管哮喘。立即停输西咪替丁,吸氧4L/min,必可酮气雾剂2喷,静滴5％葡萄糖注射液10ml+氨茶碱0.125g,静滴5％葡萄糖注射液250ml+氢化可的松琥珀酸钠 0.1g。经上述处理后,患者症状缓解。 本品引起过敏性支气管哮喘的不良反应发生率虽较低,但临床医护人员在用该药时也应高度重视,用前应询问患者药物过敏史(本患者对青霉素药物过敏),用药期间密切观察,一旦出现及时处理。
Male patient, 75 years old, due to upper abdominal pain, acid reflux for 5 years, dizziness, fatigue for 2 days, asphalted sample 1 day treatment. Hb 86g / L, WBC12.5 × 10 ~ 9 / L, BpC120 × 10 ~ 9 / L, RBC3.5 × 10 ~ (12) / L were admitted to hospital. Diagnosis of upper gastrointestinal bleeding, hemorrhagic anemia (moderate). Give 5% glucose injection 500ml + cimetidine 1.0g intravenous infusion. Infusion rate of 40 drops / min, enter the liquid 10min, the amount of fluid about 26ml sudden dry cough, sweating, exhaled breathing difficulties, cyanosis, physical examination: P 130 beats / min, rhythm Qi, R 30 times / min , BP 97 / 60mmHg (13 / 8kPa), SaO - 287%, lung smear and wheeze, consider cimetidine-induced bronchial asthma. Immediate delivery of cimetidine, oxygen 4L / min, 2 capsules aerosol spray, intravenous infusion of 5% glucose injection 10ml + aminophylline 0.125g, intravenous infusion of 5% glucose 250ml + hydrocortisone amber Sodium 0.1g. After the above treatment, the patient’s symptoms ease. This product caused by allergic bronchial asthma adverse reaction rate is low, but the clinical staff should pay attention to the use of the drug should be asked before using patients with drug allergy history (the patient allergic to penicillin drugs), during the close Observation, once appear promptly deal with.