注射用生长抑素致过敏性休克

Anaphylactic shock due to somatostatin for injection

1例51岁男性乙型肝炎肝硬化失代偿期患者因上消化道出血给予静脉滴注生长抑素3 mg持续12 h;兰索拉唑30 mg,1次/12 h;维生素K_1 10 mg,1次/d。维生素K_1和兰索拉唑于2 h输注完毕,患者未出现不适。生长抑素滴注约2.5 h时,患者出现寒颤,呼吸困难,立即停用生长抑素。约10 min后患者出现神志不清、呼之不应,心率160次/min,呼吸32次/min,血压测不到。予面罩吸氧,地塞米松10 mg静脉注射,肾上腺素1 mg皮下注射,异丙嗪25 mg肌内注射。约20 min后,患者逐渐清醒,但精神萎靡,表情淡漠。1.5 h后,寒颤、呼吸困难消失,复查心率110次/min,呼吸23次/min,血压109/50 mmHg(1 mmHg=0.133 kPa)。换用醋酸奥曲肽0.5 mg溶于0.9%氯化钠注射液60 ml,1次/12 h静脉泵入,兰索拉唑、维生素K_1继续治疗,患者未再发生类似症状。

A 51-year-old male hepatitis B patient with decompensated liver cirrhosis received IV infusions of somatostatin 3 mg for continuous 12 hours,lansoprazole 30 mg every 12 hours,vitamin K1 10 mg once daily due to upper gastrointestinal hemorrhage. The IV infusions of vitamin K1 and lansoprazole were completed within 2 hours and the patient did not present discomfort symptoms. About 2. 5 hours after the IV infusion of somatostatin,the patient developed chills and dyspnea. Somatostatin was withdrawn immediately. About 10 minutes later,he lost consciousness and had no response to voice stimuli. His heart rate was 160 times/min,respiratory rate was 32 breaths/min,and blood pressure undetectable. He was treated with oxygen mask. Intravenous dexamethasone 10 mg, subcutaneous injection of epinephrine 1 mg and intramuscular injection of promethazine 25 mg were given. About 20 minutes later,the patient slowly began to regain consciousness,but still had listlessness and apathy. His symptoms such as chills and dyspnea disappeared 1. 5 hours later,and then his heart rate was 110 times/min,respiratory rate was 23 breaths/min,and blood pressure was 109/50 mmHg. His therapy was changed to octreotide acetate 0. 5 mg in 0. 9%sodium chloride injection 60 ml every 12 hours via IV pump,lansoprazole and vitamin K1 were continued, the similar symptoms did not recur.