1例罕见的烟酸注射液致过敏性休克继发脑梗死的病例分析

Analysis of a Rare Case of Cerebral Infarction Secondary to Anaphylactic Shock Caused by Nicotinic Acid Injection

目的:为临床安全使用烟酸注射液提供参考。方法:临床药师对我院心血管内科1例高血压患者使用烟酸注射液导致过敏性休克继发脑梗死的发生与治疗过程进行介绍。通过查阅相关药品说明书及检索相关文献资料,评估该不良反应(ADR)的诱因及严重程度,提出烟酸注射液的合理用药建议。结果与结论:根据《药品不良反应报告和监测管理办法》,分析本例患者过敏性休克与烟酸注射液的关联性为"很可能",继发脑梗死主要考虑与多种危险因素(高血压、高脂血症等)有关,其中因过敏性休克、血压急剧下降导致脑灌注不足而继发脑梗死的可能性较大。以上症状不及时抢救可危及生命,定义为"严重的ADR"。临床药师建议临床在使用烟酸注射液时应当详细询问患者过敏史,从小剂量开始使用并在用药早期密切监测患者反应。对于存在脑血管疾病高危因素(高血压、高脂血症等)的患者,如发生过敏性休克,应尽快恢复有效循环血容量,待血压回升后,再使用改善微循环等药物以防止继发性脑梗死。临床药师对该类患者应及时进行用药教育,告诫患者后期就诊时务必告知医师此次严重ADR的相关药物,杜绝过敏性休克以及严重并发症的再次发生,同时在联用降压药与他汀类药物时加强血压监测及对肌肉毒性等ADR的监护,保障患者的用药安全。

OBJECTIVE:To provide reference for safe use of Nicotinic acid injection in the clinic.METHODS:The clinical pharmacist introduced the occurrence and treatment of cerebral infarction secondary to anaphylactic shock caused by Nicotinic acid injection in a patient with hypertension in the cardiovascular medicine department of our hospital.By consulting the relevant drug instructions and searching the relevant literatures,the inducement and severity of ADR were evaluated,and the rational drug use suggestions of Nicotinic acid injection were put forward.RESULTS&CONCLUSIONS:According to the Management Measures for ADR Reporting and Monitoring,the correlation between anaphylactic shock and Nicotinic acid injection was analyzed and evaluated as"very likely".Secondary cerebral infarction was mainly associated with a variety of risk factors(hypertension,hyperlipidemia,etc.),among which there was a greater possibility of secondary cerebral infarction due to insufficient cerebral perfusion caused by anaphylactic shock and sharp drop of blood pressure.The above symptoms could be life-threatening if not rescued in time,which was defined as"severe ADR".Clinical pharmacists suggest that when using Nicotinic acid injection,the patient’s allergy history should be inquired in detail,the use should be started from a small dose,and the patient’s reaction should be closely monitored in the early stage of medication.For patients with high-risk factors of cerebrovascular diseases(hypertension,hyperlipidemia,etc.),if anaphylactic shock occurs,the effective circulating blood volume should be restored as soon as possible.After the blood pressure rises,drugs such as improving microcirculation can be used to prevent secondary cerebral infarction.Clinical pharmacists should timely carry out medication education for such patients,and warn patients to inform doctors of the related drugs with severe ADR in the later stage of treatment,so as to prevent the recurrence of anaphylactic shock and severe complications.At the same time,when antihypertensive drugs and statins are combined,the blood pressure monitoring and the monitoring of ADR such as muscle toxicity should be strengthened,so as to ensure the medication safety of patients.