重庆市2015-2022年药物过敏性休克救治使用肾上腺素情况的回顾性研究

Retrospective study on the use of epinephrine in patients with drug-induced anaphylactic shock in Chongqing from 2015 to 2022

目的评价肾上腺素在药物过敏性休克救治中使用的合理性,为进一步规范过敏性休克的救治提供参考。方法依据重庆市药品不良反应(ADR)监测中心提供的2015-2022年药物过敏性休克严重ADR报告的相关数据,回顾性分析患者的救治药物选择及肾上腺素使用情况,探讨不同肾上腺素救治方案下过敏性休克患者的临床转归情况。结果共纳入1415份药物过敏性休克严重ADR报告,所涉患者男女比例为1.04∶1;引发过敏性休克的药物主要为抗感染药(47.92%)、中药注射剂(9.12%);43.96%患者的ADR发生于用药后10 min内;97.24%的患者治愈或好转,2.76%的患者死亡或未好转。1415例患者中,使用肾上腺素救治的占63.39%,首选肾上腺素救治的占53.14%;肌内注射、皮下注射、静脉注射和静脉滴注分别占33.78%、30.32%、25.75%和1.23%;肾上腺素的初始剂量范围为0.01~10 mg,单次剂量以1 mg居多(44.70%);肌内注射、皮下注射和静脉注射单次剂量过量的分别有148例(51.03%)、136例(53.13%)和193例(91.47%),静脉注射给药更有可能出现单次剂量过量(P<0.05)。初始救治使用肾上腺素者的好转/痊愈率显著高于非肾上腺素使用者(98.14%vs.96.23%,P=0.029),首选肾上腺素者的好转/痊愈率显著高于非首选肾上腺素者(98.14%vs.95.17%,P=0.031),肌内注射者的好转/痊愈率显著高于非肌内注射者(99.01%vs.96.69%,P=0.038)。结论在药物过敏性休克的救治中,存在救治药物选择不适宜和肾上腺素使用不足、给药延迟、给药途径不适宜及单次剂量过高等不合理现象。

OBJECTIVE To evaluate the rationality of epinephrine in the treatment of drug-induced anaphylactic shock,and to provide a reference for further standardizing the treatment measures of anaphylactic shock.METHODS According to the relevant data of the reports of severe adverse drug reaction(ADR)of drug-induced anaphylactic shock provided by Chongqing ADR Monitoring Center from 2015 to 2022,the selection of treatment drugs,and the application of epinephrine in anaphylactic shock were analyzed retrospectively;the clinical outcomes of anaphylactic shock with different epinephrine administration methods were investigated.RESULTS A total of 1415 cases of severe ADR related to drug-induced anaphylactic shock were reported,with a male-to-female ratio of 1.04∶1;the drugs that caused allergic shock mainly included anti-infective drugs(47.92%),TCM injections(9.12%);the patients who suffered from drug-induced anaphylactic shock within 10 min after medication accounted for 43.96%;97.24%of patients were cured or improved,and 2.76%of patients died or did not been improved.Among 1415 patients,63.39%of patients were treated with epinephrine,and the patients who preferred epinephrine treatment accounted for 53.14%;the intramuscular injection,subcutaneous injection,intravenous injection and intravenous drip accounted for 33.78%,30.32%,25.75%and 1.23%,respectively.The initial dose range of epinephrine was 0.01-10 mg,and the most frequent single dose was 1 mg(44.70%).Excessive single doses of intramuscular injection,subcutaneous injection and intravenous injection accounted for 51.03%(148 cases),53.13%(136 cases)and 91.47%(193 cases)respectively,and the risk of overdose in intravenous injection was higher(P<0.05).The patients receiving initial treatment with epinephrine had a higher improvement rate/cure rate than those who did not use epinephrine(98.14%vs.96.23%,P=0.029);the patients who preferred epinephrine had a higher improvement rate/cure rate than those who did not preferred epinephrine(98.14%vs.95.17%,P=0.031);the improvement rate/cure rate of patients receiving intramuscular injection of epinephrine was higher than those without intramuscular injection(99.01%vs.96.69%,P=0.038).CONCLUSIONS There are some unreasonable phenomena in the treatment of drug-induced anaphylactic shock,such as inappropriate selection of drugs,insufficient use of epinephrine,delay of administration,inappropriate route of administration and excessive single dose.