帕博利珠单抗注射液致过敏性休克1例

One case of anaphylaxis caused by pembrolizumab injection

1例64岁男性患者因肺恶性肿瘤行帕博利珠单抗联合化疗,予帕博利珠单抗200 mg静脉滴注时突然出现胸闷、呼吸困难,大汗淋漓,颈部及前胸发红伴瘙痒,大便失禁,血压下降,立即中止帕博利珠单抗输注,予心电监护、吸氧,予地塞米松注射液5 mg静脉注射,异丙嗪注射液12.50 mg肌注,间羟胺注射液20 mg静脉滴注,后患者症状改善,病情稳定。采用Naranjo's评估量表对该病例发生的过敏性休克与帕博利珠单抗的关联性进行评价,评分为7分,结果为“很可能有关”。本文对帕博利珠单抗注射液致过敏性休克的机制及治疗原则进行分析,为临床安全用药提供参考。

A 64-year-old male patient was treated with pembrolizumab combined with chemotherapy for lung cancer.Following the intravenous administration of 200 mg of pembrolizumab,the patient abruptly developed symptoms including chest tightness,dyspnea,profuse sweating,erythema and pruritus localized to the neck and chest,encopresis,and hypotension.The infusion of pembrolizumab was immediately stopped,and the patient was monitored with an ECG,given oxygen,and injected with 5 mg of dexamethasone and 12.50 mg of diphenhydramine.Intravenous infusion of 20 mg of metaraminol was also given,the patient's symptoms improved and the condition stabilized.According to Naranjo's Assessment Scale,the correlation score was evaluated as probably relevant.This article analyzes the mechanism and treatment principles of anaphylaxis induced by pembrolizumab injection,providing a reference for safe clinical medication.