背景:目前,对于从持续性过敏反应到严重反应的进展仍缺乏足够的了解.肾上腺素仍然是治疗严重过敏反应的首选药物,对于胃肠道症状难以缓解的I级反应患者,也可以考虑肌肉注射肾上腺素。对于持续的I级严重过敏反应,当肌肉注射效果不理想时,是否可以打破指南推荐的常规肌肉注射,值得进一步讨论。
方法:一位年轻男性,20岁,因服用中药后3天反复皮疹和6小时腹痛入院。激素治疗后,皮疹继续复发,第3天出现继发性胃肠道症状.给予肾上腺素肌肉注射以暂时缓解皮疹和腹痛,但症状仍然存在。
方法:患者被诊断为持续性严重过敏反应(I级)。
方法:在心电图监测下连续静脉输注小剂量肾上腺素,实时监测心率和血压,和甲基强的松龙的常规治疗,苯海拉明,葡萄糖酸钙,还有西替利嗪.在此期间,当腹痛症状明显时,暂时添加肾上腺素肌肉注射。整个治疗过程总共使用了6.8mg的肾上腺素。
结果:在整个肾上腺素干预期间,患者没有出现任何新的不适,心率没有异常波动,节奏,或血压。皮疹和腹痛症状逐渐好转。
结论:对于持续I级严重过敏反应的患者,在密切的生命体征监测下静脉注射低剂量肾上腺素是安全的,可行,并且在预防双相方面非常有效,持久性,或过敏反应恶化。
BACKGROUND: At present, there is still insufficient understanding of the progression from persistent allergic reactions to severe reactions. Adrenaline remains the preferred medication for severe allergic reactions, and intramuscular injection of adrenaline can also be considered for patients with grade I reactions that are difficult to alleviate gastrointestinal symptoms. It is worth further discussing whether it is possible to break the conventional intramuscular injection recommended by the guidelines when the effect of intramuscular injection is not ideal for persistent grade I severe allergic reactions.
METHODS: A young male, 20 years of age, was admitted to emergency department because of repeated rash for 3 days and abdominal pain for 6 hours after taking traditional Chinese medicine. After hormone therapy, the rash continued to recur and secondary gastrointestinal symptoms occurred on the 3th day. Adrenaline intramuscular injection was given to temporarily relieve the rash and abdominal pain, but symptoms still persisted.
METHODS: The patient was diagnosed with persistent severe allergic reaction (grade I).
METHODS: Continuous intravenous infusion of low-dose adrenaline under electrocardiographic monitoring, real-time monitoring of heart rate and blood pressure, and routine treatment with methylprednisolone, diphenhydramine, calcium gluconate, and cetirizine. During this period, adrenaline intramuscular injection is temporarily added when abdominal pain symptoms are obvious. The entire treatment process used a total of 6.8 mg of adrenaline.
RESULTS: During the entire period of adrenaline intervention, the patient did not experience any new discomfort, and there were no abnormal fluctuations in heart rate, rhythm, or blood pressure. The symptoms of rash and abdominal pain gradually improved.
CONCLUSIONS: For patients with persistent grade I severe allergic reactions, intravenous administration of low-dose adrenaline under close vital sign monitoring is safe, feasible, and highly effective in preventing biphasic, persistent, or worsening allergic reactions.