28例儿童体外循环后鱼精蛋白不良反应分析

Analysis of 28 Adverse Drug Reaction Cases of Protamine after Cardiopulmonary Bypass in Children

目的通过分析儿童体外循环手术后鱼精蛋白不良反应的临床表现及治疗方法,以期为临床安全用药提供参考。方法对28例儿童体外循环后鱼精蛋白不良反应患者的年龄、性别、用药剂量、给药途径、不良反应临床表现、不良反应发生时间、不良反应的处置、超滤对鱼精蛋白不良反应发生率的影响等进行回顾性分析。结果 28例鱼精蛋白不良反应的患儿均出现不同程度的低血压,其中27例患儿经常规治疗后血压恢复至正常,1例患儿再次行体外循环辅助30min后病情好转并脱机;所有出现鱼精蛋白不良反应的患儿无临床死亡;体外循环中进行超滤的患儿鱼精蛋白不良反应的发生率低于未行超滤的患儿(P=0)。结论在儿童体外循环后使用鱼精蛋白可导致严重的药品不良反应,在体外循环过程中进行超滤可能有助于减少鱼精蛋白不良反应的发生。

Objective To analyze the clinical features and treatment in ADR cases of protamine after cardiopulmonary bypass in children, in order to provide a reference for clinical safe medication. Methods 28 ADR cases of protamine after cardiopulmonary bypass in children with age, sex, dose, route of administration, clinical manifestations of adverse reactions, adverse reaction time, the management of adverse reaction, effect of ultrafiltration on incidence of adverse reaction were analyzed retrospectively. Results 28 patients were caused hypotension after protamine injection. After emergency treatment, 27 cases returned to normal blood pressure, while 1 patient got better in 30rain cardiopulmonary bypass rebuilt, no clinical death happened. The incidence of adverse reactions of protamine with ultrafiltration was lower than no ultrafiltration（P=0）. Conclusion Protamine may cause severe ADR after cardiopulmonary bypass in children. Ultrafiltration may be the key to lower the incidence of severe ADR.