呼吸系统过敏反应的急救

Emergent treatment of the anaphylasis of the respiratory system in human

目的：总结呼吸系统过敏反应急救的经验。方法：回顾2例呼吸系统过敏反应和1例类过敏反应抢救的过程，分析成功和失败的原因。结果：本组3例中2例抢救成功，1例死亡。结论：呼吸系统过敏反应发病突然，发展很快。其分二种类型：上气道梗阻和下气道弥漫性支气管痉挛，抢救措施有很大差别。首先要皮下注射肾上腺素。上气道梗阻要作气管插管或紧急气管切开，保证通气。第二种类型则吸入β-2拟交感神经药物，或注射氨茶碱，并吸氧；呼吸道分泌物及时有效的清除尤为重要，否则，瞬间肺的气体交换被完全阻断。强调变应原试验室和常规注射室除准备必要的抢救药物外，还应准备吸痰器、气管插管和气管切开等器械。

objective. To summarize the experience of the emergent treatment of anaphylaxis and anaphylactoid reaction of the respiratory system in human. Methods.Two patients with anaphylaxis and one with anaphylactoid reaction of the respiratory system in recent 4 years were retrospectively analysed and the keys of success and fail were discussed in detail. Results. The emergent treatment were successful in 2 cases and failed in one. Conclusions. There are two patterns of anaphylaxis in respiratory system.The first one is upper airway abstruction owing to edema of the larynx and/or epiglottis,which can cause acute distress and death. The second one involves in diffusive lower airway bronch constriction in which air flow limitation can not be relieved by endotracheal intubation and may lead to lethal abnormalities of pulmonary gas exchange. These three cases belonged to the second pattern. Solution of epinephrine should administrated subcutaneously as soon as anaphylaxis was diagnosed. Severe laryngeal and/or epiglottic edema reguired either endotracheal intubation or an emergent tracheostomy to facilitate ventilation. Inhalation of β-2 sympathominetics or intraveneous aminophylline was need ed in the diffusive bronchospasm as well as enough oxygen supply and clearence of secre tion in hypopharynx and trachea. It should be pointed out emphatically that the aspirator and instruments for endotracheal intubation and tracheostomy should be always prepared in the allergic test room and injection room.