肌肉注射维生素K_1过敏的临床证据

Evidence for Anaphylaxis Induced by Intramuscular Injection of Vitamin K_1

尽管维生素K1过敏临床罕见,但我科近期在肾活检前肌注维生素K1后先后发生了4例过敏反应。为提供最佳证据指导临床治疗,作者对MEDLINE数据库(截至2005年5月)中有关维生素K1过敏的研究进行了检索和评价。结果发现,维生素K1过敏的相关研究仅为个案报告或回顾性分析。其主要反应为过敏性皮炎,皮疹表现多样,出现和持续时间不一,而过敏性休克等严重副反应极少发生。在肾活检前常规使用维生素K1应注意以下几点:①对于并无维生素K1缺乏或低凝血酶原血症的患者不必常规使用,尤其是在用于非促进止血用途时应尽可能换用其他作用相似的药物;②如果确有必要使用,在非紧急情况下应尽量避免静脉内使用;③维生素K1过敏的发生率不高且程度较轻,因此不推荐在使用该药的同时常规使用抗组胺药物和糖皮质激素。同时应加强药物不良反应的监测工作。

Although anaphylaxis induced by vitamin K1 seldom happens, 4 allergic cases were observed in the patients we treated recently who were given intramuscular injection of vitamin K1 before renal biopsy. To provide the best clinical evidence, we searched MEDLINE （-May 2005） and evaluated the studies. The studies were only case reports and retrospective reviews which showed the anaphylaxis were mainly allergic dermatitis with different manifestation and reaction time. The serious reactions such as allergic shock was very rare. We conclude that although vitamin K1 anaphylaxis is rare, strict indications should be followed and the drug surveillance on adverse events should be strengthened.