低分子右旋糖酐氨基酸注射液致严重过敏性休克1例

One case of anaphylactic shock induced by dextran 40 and amino acids injection

1例28岁足月孕妇,既往体健,无药物和食物过敏史。入院行剖宫产术,手术顺利,生命体征平稳。术后静脉滴注低分子右旋糖酐氨基酸注射液250 m L,开始输注后5 min,患者出现全身皮肤瘙痒、恶心等症状。立即停用该药,给予吸氧、地塞米松注射液5 mg治疗,5 min后病情呈进行性加重至过敏性休克。遂给予地塞米松注射液10 mg、盐酸肾上腺素注射液1 mg、盐酸多巴胺注射液20 mg,2 min后心跳骤停。即刻行气管内插管、持续胸外心脏按压、呼吸支持、心电监护的同时进入手术室抢救。抢救后生命体征趋于稳定,但意识不清。之后转入重症医学科、神经内科重症监护室继续治疗43 d,患者生命体征平稳,神志逐渐恢复。

One 28-year-old full-term pregnant woman with a healthy history had no allergic history of drug and food. After admission, she accepted cesarean section. The surgery went well, and vital signs of the patient were stable. About 5 minutes after the beginning of intravenous infusion of dextran 40 and amino acids injection with 250 mL, the patient complained body itching, nausea and other allergic symptoms. Then the intravenous infusion was stopped at once, at the same time oxygen inhalation and dexamethasone injection 5 mg were given. However, the condition progressed to anaphylactic shock within 5 minutes. Immediately, dexamethasone injection 10 mg, adrenaline hydrochlodde injection 1 mg and dopamine hydrochloride injection 20 mg were applied. Nevertheless, cardiac arrest took place in 2 minutes over. Momentarily, the patient was sent into the resuscitation room, and endotracheal intubation, sustainable external chest cardiac compression, respiratory support and electrocardiographic monitoring were given at the same time. After the rescue, the patient＇s vital signs restored, but she was in a coma state. After treatment in intensive care unit （ICU） and neurology intensive care unit （NICU） for 43 days, her vital signs were stable, and consciousness recovered at last.