聚明胶肽致过敏性休克误诊为肺栓塞

Anaphylactic shock induced by polygeline misdiagnosed as pulmonary embolism

1例51岁女性患者因宫颈癌术后并发盆腔淋巴囊肿感染行囊肿切除术,术后当日先后给予注射用尖吻蝮蛇血凝酶2U溶于0.9%氯化钠注射液100ml静脉滴注,10%氯化钾注射液15ml加入10%葡萄糖注射液500ml静脉滴注,聚明胶肽注射液500ml静脉滴注。当聚明胶肽注射液输入约100ml时,患者突发意识丧失,呼吸10次/min,心率120次/min,血压70/50mmHg(1mmHg=0.133kPa),血氧饱和度0.70。考虑为肺栓塞,给予兴奋呼吸、升压及肝素抗凝治疗,但症状无缓解且继续加重,血压下降至0。抢救28min后,因观察到患者皮肤潮红,考虑可能为聚明胶肽注射液所致过敏性休克,立即停止输注聚明胶肽注射液,并给予抗过敏、抗休克治疗,患者血压有所回升,但仍不稳定。心脏超声检查示患者心包积液较手术前增多,急行心包穿刺术,抽出积液约80ml并留置引流管。继续抗过敏、抗休克治疗,约50min后患者意识恢复,约11h后血压135/85mmHg,呼吸18次/min,心率100次/min,血氧饱和度1.00。

A 51-year-old female patient underwent resection of lymphatic cyst because of the infection of her pelvic lymphatic cyst after the cervical cancer operation.After the operation,the patient was given sequentially IV infusions of haemocoagulase agkistrodon for injection 2 units(dissolved in 0.9% sodium chloride injection),10% potassium chloride injection 15 ml(added to 10% glucose injection 500 ml),and polygeline injection 500 ml.When about 100 ml of polygeline injection was infused,the patient suddenly lost consciousness,and her breath rate was 10 times/min,heart rate was 120 beats/min,blood pressure was 70/50 mmHg,and oxygen saturation was 0.70.Pulmonary embolism was considered and respiratory stimulants,hypertensors,and heparin were given,but the patient's symptoms continued to worsen and her blood pressure dropped to 0.After 28 minutes of the rescue,allergic shock caused by polygelatin peptide injection was considered because of the flushing of the patient's skin.The polygeline injection was stopped immediately,and then antianaphylaxis and antishock treatments were given.The patient'sblood pressure began to recover but remained unstable.Echocardiography showed more pericardial effusion than before the operation.Pericardiocentesis was urgently implemented,draining about 80 ml of effusion,and the drainage tube was indwelled.Antianaphylaxis and antishock treatments were continued.About 50 minutes later,the patient regained consciousness.And about 11 hours later,her blood pressure was 135/85 mmHg,breath rate was 18/min,heart rate was 100 beats/min,and oxygen saturation was 1.00.