生物合成人胰岛素注射液致过敏性休克

Anaphylactic shock caused by biosynthetic human insulin injection

1例75岁糖尿病女性患者因右桡骨远端骨折拟行手术治疗。术前禁食期间给予5%葡萄糖氯化钠注射液500 ml+生物合成人胰岛素注射液(诺和灵R)6 U静脉滴注,无其他并用药物。输液前测指尖血糖10.6 mmol/L。液体输注约3 min(输入液体约8 ml),患者突然全身发冷、恶心,随之意识丧失、呼之不应、口吐白沫、双上肢抖动、小便失禁。指尖血糖9.6 mmol/L,可排除低血糖反应。心电监护显示,血压最低37/27 mmHg(1 mmHg=0.133 kPa),血氧饱和度0.40,考虑为生物合成人胰岛素导致的过敏性休克。先后给予静脉泵入多巴胺、去甲肾上腺素,皮下注射肾上腺素和静脉滴注地塞米松等抗过敏、抗休克治疗,3 h后患者恢复正常。

A 75-year-old female patient with diabetes mellitus was scheduled for surgery due to right distal radius fracture.She was given an IV infusion of 5%glucose and sodium chloride injection 500 ml+biosynthetic human insulin injection(Novolin R)6 U during fasting before operation,and no other drugs were concomitantly used.Her fingerstick glucose was 10.6 mmol/L before the IV infusion.At about 3 minutes of fluid infusion(infused fluid was about 8 ml),the patient suddenly developed chills all over the body and nausea,followed by consciousness loss,no response to verbal stimuli,foam at mouth,convulsions of both upper limbs,and incontinence of urine.Finger-stick glucose was 9.6 mmol/L and hypoglycemic reaction could be ruled out.Electrocardiogram monitoring showed the lowest blood pressure 37/27 mmHg and oxygen saturation 0.40.Anaphylactic shock due to biosynthetic human insulin was considered.Anti-anaphylactic and anti-shock treatments such as intravenous pumping of dopamine and norepinephrine,subcutaneous injection of epinephrine,and intravenous infusion of dexamethasone were given successively.