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患者男,68a。患慢性咳嗽咳痰40余年,咳嗽常于冬季出现,20年前伴发喘息,咳嗽喘息逐年加重,发作频繁,四季均有发作,曾院内外多家医院住院治疗。诊断:慢性喘息型支气管炎,慢性阻塞性肺气肿,慢性肺源性心脏病。查体:平卧位,喘状,双肺闻哮鸣音,心率84次/min,肝肋下3cm,双下肢轻度水肿。辅助检查符合肺气肿,肺心病诊断,因咳喘加重二周再入院。住院期间曾静点青霉素治疗。住院d9做先锋必皮试阴性,予先锋必3g加入5％葡萄糖液250ml静点。静点10min患者突然呼吸困难,口唇紫绀,大汗,大声呼叫,端坐呼吸,血压180/90mmHg,双肺呼吸音弱。考虑先锋必过敏,立即停先锋必,静推地塞米松10mg,静点琥珀氢化可的松100mg。15min后,喘息明显好转,病人安静,可平卧,双肺散在哮鸣音。 讨论:青霉素与头孢类抗生素都属于β-内酰胺类,头孢类和青霉素存在交叉过敏反应不除外,无青霉素过敏者,可直接应用头孢类抗生素。本例青霉素无过敏反应,先锋必皮试阴性,静点先锋必后出现严重过敏反应,表现为双肺支气管痉挛。哮端发作。
Patient male, 68a. Chronic cough and phlegm for more than 40 years, cough often appear in winter, 20 years ago with wheezing cough and wheezing increased year by year, frequent seizures, seasons have seizures, many hospitals have hospital treatment. Diagnosis: Chronic asthmatic bronchitis, chronic obstructive pulmonary emphysema, chronic cor pulmonale. Physical examination: supine position, wheezing, wheezing lung smell, heart rate 84 beats / min, liver ribs 3cm, mild lower extremity edema. Auxiliary examination in line with emphysema, pulmonary heart disease diagnosis, due to cough and exacerbation of two weeks and then admission. Have static point penicillin treatment during hospitalization. D9 to be a pioneer in hospital Pipi negative test, to Pioneer 3g 5% glucose solution 250ml static point. Suddenly 10min calm patients breathing difficulties, cyanotic lips, sweating, loudly call, sit and breathe, blood pressure 180 / 90mmHg, lung breath sounds weak. Pioneer will consider the allergy, stop the Pioneer will be static push dexamethasone 10mg, static amber hydrocortisone 100mg. After 15min, wheezing significantly improved, the patient was quiet, lying, lungs scattered wheeze. Discussion: penicillin and cephalosporin antibiotics belong to β-lactams, cephalosporins and penicillin cross-allergic reactions are not excluded, no penicillin allergy, cephalosporins can be directly applied antibiotics. Penicillin in this case no allergic reactions, Pioneer skin test negative, static point will emerge serious allergic reactions, manifested as double lung bronchospasm. Asthma attack.