钆贝葡胺引起严重过敏反应2例

Severe anaphylaxis due to gadobenate dimeglumine

2例患者分别因行腰椎和中腹部核磁共振检查(例1男,77岁;例2女,27岁)给予钆贝葡胺静脉注射,给药1 min后均出现严重过敏反应。例1表现为口唇发麻、恶心、胸闷,此后相继出现口唇肿胀发绀、气促,吸气性呼吸困难,悬雍垂水肿,舌体肿胀等。例2表现为口唇发麻、刺激性呛咳、血压升高,此后相继出现口唇发绀、流涎、气促、吸气性呼吸困难,全身散在皮疹,扁桃体Ⅲ度肿大,悬雍垂水肿等。均被诊断为钆贝葡胺引起的严重过敏反应。先后给予高流量吸氧、甲泼尼龙静脉注射、肾上腺素皮下注射、异丙嗪肌内注射、沙丁胺醇和布地奈德雾化吸入、维生素C及葡萄糖酸钙静脉滴注等抗过敏治疗。例1症状无改善,立即行环甲膜穿刺术及气管切开术,患者呼吸困难缓解,舌体、悬雍垂肿胀逐渐缓解。例2抗过敏治疗1 h后呼吸困难缓解;1.5 h后皮疹消退,扁桃体和悬雍垂水肿减轻。

Two patients(patient 1,a 77-year-old male;patient 2,a 27-year-old female)received intravenous injection of gadobenate dimeglumine before magnetic resonance imaging(MRI)on lumbar vertebra and midabdomen,respectively.One minute after the administration,the patients both developed severe anaphylaxis.Patient 1 manifested as numbness of lips,nausea,and chest tightness.After that,he developed swelling and cyanosis of lips,shortness of breath,inspiratory dyspnea,edema of uvula,and swelling of tongue.Patient 2 manifested as numbness of lips,irritating cough,and elevated blood pressure.After that,cyanosis of lips,salivation,shortness of breath,inspiratory dyspnea,scattered rashes all over the body,grade ID of tonsil enlargement,and edema of uvula successively appeared.They were diagnosed with severe anaphylaxis induced by gadobenate dimeglumine.Treatments such as high flow oxygen inhalation,intravenous injection of methylprednisolone,subcutaneous injection of adrenaline,intramuscular injection of promethazine,atomization inhalation of salbutamol and budesonide.and intravenous infusion of vitamin C and calcium gluconate were successively given.Symptoms in patient 1 were not improved and the cricothyroid membrane puncture and tracheotomy were performed immediately.Then his dyspnea was relieved and the swelling of tongue and uvula was gradually relieved.Dyspnea in patient 2 was relieved 1 hour after the anti-allergic treatments,one and a half hours later,her rash subsided and edema of tonsil and uvula were relieved.