肾上腺素联合苯海拉明在急诊救治重症过敏性休克患者中的疗效观察

Clinical effect of Adrenaline combined with Diphenhydramine in the emergency treatment of severe anaphylactic shock

目的探讨肾上腺素联合苯海拉明在急诊救治重症过敏性休克患者中的临床疗效及应用价值。方法选取2017年1月至2019年4月在本院急诊科救治的42例重症过敏性休克患者,根据起病原因及轻重程度分为观察组(n=24)和对照组(n=18)。在急诊救治过程中,除常规采取吸氧、扩容、升压等对症处理措施外,观察组患者应用肾上腺素联合苯海拉明静脉推注治疗,对照组患者仅给予肾上腺素治疗。监测两组患者血压回升时间、皮疹消退时间以及苏醒时间,比较两治疗方案不同时间点的静脉补液量、心排量和中心静脉压变化,分析两组患者急诊救治的成功率,以评估临床疗效。结果经抢救后,观察组患者平均血压回升时间、皮疹消退时间以及苏醒时间均短于对照组(P<0.05)。治疗前,两组患者心排量、中心静脉压水平比较差异无统计学意义。治疗后,两组不同时间心排量比较差异有统计学意义(P<0.05)。急救后1、2、3、5 h,观察组心排量水平均高于对照组(P<0.05)。观察组急救前与急救后1 h中心静脉压水平比较差异无统计学意义,急救后不同时间点水平两两比较差异有统计学意义(P<0.05)。观察组抢救成功率高于对照组,差异有统计学意义(P<0.05)。结论肾上腺素联合苯海拉明可有效缓解重症过敏性休克的临床症状,促进患者早期苏醒,在提高急诊救治成功率方面具有协同作用。

Objective To explore the clinical effect and application value of epinephrine combined with diphenhydramine in emergency treatment of severe anaphylactic shock.Methods From January 2017 to April 2019,42 patients with severe anaphylactic shock who were treated in the emergency department of our hospital were divided into the observation group(n=24)and the control group(n=18)according to the cause and severity of the disease.In the course of emergency treatment,in addition to routine measures such as oxygen inhalation,volume expansion and pressure rise,the patients in the observation group were treated with epinephrine combined with diphenhydramine intravenous injection,while the patients in the control group were only treated with epinephrine.The time of blood pressure rising,the time of skin rash subsiding and the time of recovery were monitored in the two groups.The volume of intravenous fluid,cardiac output and central venous pressure were compared at different time points in the two treatment schemes.The success rate of emergency treatment in the two groups was analyzed to evaluate the clinical effect.Results After rescue,the average blood pressure rise time,rash remission time and wake-up time of the observation group were shorter than those of the control group(P<0.05).Before treatment,there was no statistically significant difference in cardiac output and central venous pressure between the two groups.After treatment,the cardiac output of the two groups was not the same at different times,and the difference was statistically significant(P<0.05).At 1,2,3,and 5 hours after first aid,the cardiac output level of the observation group was higher than that of the control group(P<0.05).There was no statistically significant difference in the central venous pressure level of the observation group before and 1h after the emergency,and there was a statistically significant difference in the level at different time points after the emergency(P<0.05).The rescue success rate of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Adrenaline combined with diphenhydramine can effectively alleviate the clinical symptoms of severe anaphylactic shock,promote the early recovery of patients,and have a synergistic effect in improving the success rate of emergency treatment.