1、药物过敏试验及过敏反应的处理药物过敏试验及过敏反应的处理MedicationallergytestandmanagementofallergicreactionTracyZhaoContent Penicillin allergy test Streptomycin allergy test Tetanus allergy test Cephalosporin allergy test Iodine allergy test Procaine allergy test学习目标学习目标 掌握青霉素过敏试验方法、结果判断、过敏掌握青霉素过敏试验方法、结果判断、过敏反应的临床表现、预防和急救处理原则
2、。反应的临床表现、预防和急救处理原则。掌握掌握TATTAT脱敏注射法。脱敏注射法。熟悉青霉素过敏反应的原因。熟悉青霉素过敏反应的原因。熟悉链霉素、破伤风抗毒素、普鲁卡因、碘熟悉链霉素、破伤风抗毒素、普鲁卡因、碘过敏试验的方法及结果判断。过敏试验的方法及结果判断。Case study：One patient has got penicillin skin test 5min before,now he suddenly feels chest tightness,shortness of breath with pale,cold sweat,his blood pressure is at 1
3、0/7.0Kpa(75/52mmHg),pulse is weak.What is this phenomenon?How do you manage it if you are a nurse on duty？.The most severe alergic reaction is also called anaphylaxis or anaphylactic shock1.stop medicine.2.give 0.1%adrenaline(epinephrine)via subcutaneous injection.3.oxygen inhalation.4.anti-allergy5
4、.correction of acidosis.6.expand blood volume.7.resuscitation.8.close observation of diseasev The sooner that epinephrine is given,the greater the chance for survivalThe treatment on anaphylactic shock must be prompt,grasp every minute and second,start rescue withou moving,adopt effective measures a
5、nd close observation Have the person lie flat,raise his feet,and cover him or her with a warm blanket.give oxygenGive injection of 0.1%epinephrine 0.5 1ml at onceIf symptoms is not remission,give 0.1%epinephrine 0.5ml every half hour.If cardiac arrest is occurred,start CPR immediately 肾上腺素是抢救过敏性休克的首
6、肾上腺素是抢救过敏性休克的首选药物，具有收缩血管、增加外选药物，具有收缩血管、增加外周阻力、提升血压、兴奋心肌、周阻力、提升血压、兴奋心肌、增加心输出量以及松弛支气管平增加心输出量以及松弛支气管平滑肌等作用滑肌等作用Give oxygen to improve hypoxia.conduct mouth-to-mouth artificial respiration if Respiratory arrest,give respiratory stimulant Nikethamide,lobelinevia intramuscular injection asphyxia induced b
7、y Laryngeal edema ,should perform endotracheal intubation or tracheotomy and connect artificial respiratoras soon as possible Anti allergy treatment.Give dexamethasone 5 10mg or hydrocortisone sodium succinate 200 400mg in 5%10%glucose solution 500ml via intravenous infusionGive antihistamine drugs,
8、promethazine hydrochloride 25 50mg or diphenhydramine 40mg via intramuscular injections Give intravenous infusion of 10%dextrose or Ringers solution.according to doctors orders give dopamine or norepinephrine via intrvenous infusionCorrection of acidosisAcupuncture of Neiguan Zusanli,Close observati
9、on and recording V/S,urinary output,consciousness.Do not move patient before he is not out of danger Evaluate treatment effect,and provide the basis for further management青霉素青霉素机体皮肤、消化道、呼吸道症状及过敏性休克等组织胺缓激肽5-羟色胺血管扩张 通透性增强 平滑肌收缩 腺体分泌增加 全抗原Ig E肥大细胞 嗜碱性粒细胞 青霉素过敏反应 family幻灯片幻灯片 11,alergic,medication alerg
10、ic test Accurate test solution Strictly master method Correctly judg results 现用现配药液现用现配药液 每次注射后观察半小时每次注射后观察半小时 做好急救的准备做好急救的准备l减少青霉稀减少青霉稀酸的产生酸的产生,防防止过敏反应的止过敏反应的发生发生;l防止青霉素防止青霉素水溶液的效价水溶液的效价在室温中下降在室温中下降,影响治疗效果影响治疗效果 N:Mr.Zhao,you have got pneumonia.Well give you some penicillin injections.First,Ill giv
11、e you a penicillin allergy test.Have you used penicillin before?P:Yes,I have.N:Are you allergic to it?P:No,never.N:Is there anybody else in your family allergic to it?P:I think there is nobody.N:Are you allergic to any other drugs?P:No.青霉素过敏性休克青霉素过敏性休克属属型变态反应，型变态反应，发生率约为发生率约为5 51010个个/1/1万万特点是危险性大、特
12、点是危险性大、一般呈闪电样发生，一般呈闪电样发生，5%患者于给药后患者于给药后5分钟内出现症状，分钟内出现症状，10%出现于半小时以后，出现于半小时以后，既可发生于皮内试验过程中，既可发生于皮内试验过程中，也可发生于初次注射时，也可发生于初次注射时，也有极少数患者发生于连续用药的过程中也有极少数患者发生于连续用药的过程中 由于喉头水肿由于喉头水肿支气管痉挛支气管痉挛肺水肿所引起肺水肿所引起Chest tightnessChest tightnessShortness of breathShortness of breathAsthmaAsthmaDyspneaDyspnea由于由于周围血管扩张
13、周围血管扩张导致有效导致有效循环血量不足循环血量不足PaleCold sweatCyanosisWeak pulseA drop in blood pressure因脑组织因脑组织缺氧所致缺氧所致 Dizzy limbs numbness Loss of consciousnessTwitch Incontinent of urine and bowel Urticaria nausea vomiting abdominal pain diarrhea feverserum sickness-like reaction于用药后714天出现，临床表现与血清病相似，Fever,Joint swel
14、ling and pain,Itchy skin,Urticaria,Generalized lymphadenopathy abdominal pain 皮肤过敏反应皮肤过敏反应 瘙痒瘙痒荨麻疹荨麻疹严重者严重者发生剥脱性皮炎发生剥脱性皮炎呼吸道过敏呼吸道过敏反应反应 可引起哮喘可引起哮喘或促发原有或促发原有的哮喘发作的哮喘发作消化道过敏反应消化道过敏反应 可引起可引起过敏性紫癜过敏性紫癜以腹痛和便血以腹痛和便血为主要症状为主要症状 试液标准配制方法试验方法结果判断青霉素青霉素 80万万u+N.S 4ml=20万万u/ml吸吸 0.1ml+N.S至至1ml=2万万u/ml(弃去弃去.ml)余
15、余 0.1ml+N.S至至1ml=2000u/ml(弃去弃去.ml)余余0.1ml+N.S 至至1ml=200u/ml negtivenegtive（）postivepostive 皮丘皮丘无无改变改变周围不红肿周围不红肿无无红晕红晕无无自觉症状自觉症状 皮丘隆起增大出现红晕直径大于1cm周围有伪足伴局部痒感严重时可有头晕心慌、恶心甚至发生过敏性休克Watery,red eyes 几种常用药物过敏试验法配制方法链霉素链霉素100万万u+N.S 3.5ml=25万万u/ml吸吸 0.1ml+N.S至至1ml=2.5万万u/ml(弃去弃去.ml)余余0.1ml+N.S 至至1ml=2500u/ml
16、一次溶解次溶解二次稀释二次稀释三、破伤风抗毒素过敏反应试验及脱敏注射法 破伤风抗毒素（tetanus antitoxin,TAT)是马的免疫血清，对人体是一种异种蛋白，具有抗原性，注射射后易出现过敏反应。TAT引起过敏反应率5%30%，其中有约十万分之一的致死率。用过TAT超过1周者，如需再用，应重做过敏试验。（一）过敏试验法1、试验液的配制2、试验方法 剂量：15 IU 时间：20分钟 结果判断：阴性：局部无红肿、无异常全身反应。阳性：皮丘红肿，硬结直径大于1.5cm，红晕范围直径超过4cm，有时出现伪足或有痒感。全身反应以血清病型反应多见。处理：阴性可把所需剂量一次注射完。阳性需采用脱敏注
17、射法。脱敏注射法是将所需TAT剂量分多次少剂量间隔20min密切观察下注射到患者体内 time TAT N.S method 1 0.1ml 0.9ml 2 0.2ml 0.8ml I M 3 0.3ml 0.7ml 4 余量余量 至至1ml四、普鲁卡因与碘过敏试验（一）普鲁卡因过敏试验1、过敏试验方法 剂量：0.25%普鲁卡因0.1ml（25mg）2、结果判断和处理同青霉素。（二）碘过敏试验1、过敏试验方法（1）口服法：5%10%碘化钾5ml，tid3天（2）皮内注射法：造影剂0.1ml ID。（3）静脉注射法：造影剂1ml IV。2、结果判断（1）口服法：口麻、头晕、心慌、荨麻疹等。（2）皮内注射法：局部红肿硬结1cm。（3）静脉注射法：有血压、脉搏、呼吸等改变。任务单任务单 请将一只请将一只80万万u的青霉素配制成的青霉素配制成500 uml的青霉素的青霉素皮试液？皮试液？
