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患者,女,20岁,因发冷发热,鼻塞、咽痛、咳嗽等症就治。查T39.1℃,P108次/分,R22次/分,BP16.0/10.6kPa,咽部充血、扁桃体轻度肿大,表浅淋巴结未扪及,心肺(-),拟诊“上感”。给予柴胡注射液4ml,庆大霉素8万U,混合肌注,当注射完毕时,患者立即发生头昏心慌,呼吸困难,面色苍白,全身冷汗,皮肤湿冷,心率50次/分,BP9.3/6.7kPa,脉搏扪不到,诊断为过敏性休克,给予肾上腺素1mg肌注,3分钟后病情缓解,生命体征逐步恢复正常。讨论:追询病史,病人无注射柴胡、庆大霉素史,所发生休克究竟是对二药中何种药物过敏或配伍后所致过敏,尚无定论。不过,笔者以为: 一、从致敏性来看,可能有四:①对庆大霉素过敏,②对柴胡注射液过敏,③对柴胡、庆大均过敏,④对二药混合后产生新的物质过敏。二、从过敏史来看,患者除此次过敏外,既往无任何药物过敏史。
Patients, female, 20 years old, due to chilly fever, stuffy nose, sore throat, cough embolism rule. Check T39.1 ℃, P108 beats / min, R22 beats / min, BP16.0 / 10.6kPa, pharyngeal hyperemia, tonsil mild enlargement, superficial lymph nodes not palpable, cardiopulmonary (-), ". Given Bupleurum injection 4ml, gentamicin 80,000 U, mixed intramuscular injection, when the injection is completed, the patient immediately dizziness, difficulty breathing, pale, cold sweat, skin wet and cold, heart rate 50 beats / min, BP9 .3 / 6.7kPa, palpable pulse, diagnosed as anaphylactic shock, intramuscular injection of 1mg epinephrine, 3 minutes after the remission, the signs of life gradually returned to normal. Discussion: Pursuit of medical history, patients with no injection of Bupleurum, gentamicin history, what happened to the shock of what kind of drug in the two drugs allergy or compatibility allergies, no conclusive. However, the author thinks: First, from sensitization point of view, there may be four: ① allergic to gentamicin, ② allergic to Bupleurum injection, ③ Bupleurum, Kyrgyzstan were allergic to ④ after the two drugs mixed Have a new substance allergy. Second, from the history of allergy, the patient in addition to the allergy, the past without any history of drug allergy.