静脉输注细胞毒性药物导致集中发生过敏反应的案例探析

Case Study of Allergic Reactions Induced by Intravenous Infusion of Cytotoxic Drugs

目的:探讨夏季细胞毒性药物输注后集中发生过敏反应的可能影响因素,为回顾性调查提供方案参考,避免因输注细胞毒性药物而造成更多过敏病例的出现。方法:结合2019年6—7月北京市某三级甲等医院肿瘤内科引发多起过敏反应的细胞毒性药物的调查,针对同批次药品及涉事医嘱药品的储存和使用情况,排查可能引起输液反应的诱因。结果:经对药品的供应、储存、配置等环节的调查,此次集中过敏反应排除了输液反应的可能。但经综合分析后发现,(1)成品输液在运往科室时暴露于夏季室外环境下,会破坏输液质量的稳定性;(2)盛夏时节,由于患者生活在高温高湿环境下,其免疫功能可能会发生异常。因此,高温高湿的环境是导致此次药物输注后集中发生过敏反应的主要原因。结论:在夏季环境下抗肿瘤药致过敏反应的发生率将会升高,因此,对温度敏感的细胞毒性药物应实行现用现配,并应控制病房的湿度和温度,加强对患者的监护与护理。

OBJECTIVE:To probe into the possible factors that influencing the allergic reactions after intravenous infusion of cytotoxic drugs in summer,and to provide the protocol reference for retrospective investigation to avoid more cases of allergic reactions induced by intravenous infusion of cytotoxic drugs.METHODS:Combined with the investigation of cytotoxic drugs that induced multiple allergic reactions in the oncology department of a GradeⅢ,level A hospital in Beijing from Jun.to Jul.2019,the possible causes of infusion reactions were investigated according to the storage and use of the same batch of drugs and the drugs involved in the medical order.RESULTS:Through the investigation of supply,storage and configuration of the drug,the allergic reactions ruled out the possibility of infusion reactions.However,after comprehensive analysis,it is found that,(1)the finished infusion solution was exposed to the outdoor summer environment when transported to the department,which could damage the stability of the quality of the infusion solution;(2)in the peak of summer,the immune function of patients might be abnormaldue to the higher temperature and humidity environment.Therefore,the higher temperature and humidity environment was the main cause of allergic reactions after drug infusion.CONCLUSIONS:In summer,the incidence of allergic reactions to antineoplastic drugs will increase.Therefore,temperature-sensitive cytotoxic drugs should be dispensed on the spot,and the humidity and temperature of the ward should be controlled to enhance patient monitoring and care.