静注人免疫球蛋白(pH4)皮下渗出的不良反应原因分析及其处理建议

The cause analysis and treatment suggestions of adverse reactions after human intravenous immunoglobulin(pH4)subcutaneous exudation

目的探讨静注人免疫球蛋白(human intravenous immunoglobulin,IVIG)(pH4)外渗不良反应发生的影响因素。方法临床收集1例儿童IVIG皮下渗出的不良反应个案资料,并采用回顾性研究分析方法,对截至2020年10月国内外报道的37例IVIG皮下外渗病例,分别对基础用药信息、肿胀部位、不良反应处理及转归进行统计分析。结果37例病例中男20例、女16例、不详1例,年龄为1日龄至26月龄,主要为新生儿。所有病例均在IVIG皮下渗出后发生不良反应。IVIG皮下渗出后肿胀部位主要发生于手背(29.73%)和脚踝(29.73%),其他部位依次为肘部(18.92%)、足背(13.51%)、腘窝(5.41%)、头皮(2.70%)。对肿胀部位应急局部封闭处理后,肿胀消除效果明显,湿性敷料和外用药物有明显效果。结论IVIG皮下渗出后不良反应与患者年龄、输注部位等因素存在一定的关系。当儿童使用IVIG发生皮下渗出时,采用文献中提到的方法对相应部位进行处理,可有效缓解和治疗对皮肤组织的损伤。

Objective To investigate the influencing factors for adverse reactions after the extravasation of human intravenous immunoglobulin(IVIG)(pH4).Methods One clinical IVIG subcutaneous extravasation case and 37 cases reported in medical academic journals worldwide as of October 2020 were retrospectively analyzed from the aspects of basic medication information,swelling site,adverse reaction treatment and outcome.Results In 37 cases,there were 20 males,16 females and 1 unknown case aged from 1 day to 26 months,mainly newborns.All cases had adverse reactions after IVIG subcutaneous exudation.The swelling mainly occurred in the dorsum of hand(29.73%)and ankle(29.73%).Other swelling parts were elbow(18.92%),dorsum of foot(13.51%),popliteal fossa(5.41%),and scalp(2.70%).After emergency local closure of the swelling part,the swelling was obviously eliminated.Wet dressing and topical drugs had significant effect.Conclusions The adverse reactions after IVIG subcutaneous exudation have relationship with the age of patients,the place of infusion,etc.When subcutaneous exudation occurs,especially in infants,the method mentioned in literature can effectively alleviate and treat the damage to skin tissue.