药物过敏试验及过敏反应的处理.ppt

药物过敏试验及过敏反应的处理Medicationallergytestandmanagementofallergicreaction,TracyZhao,Content,PenicillinallergytestStreptomycinallergytestTetanusallergytestCephalosporinallergytestIodineallergytestProcaineallergytest,学习目标,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。掌握TAT脱敏注射法。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、碘过敏试验的方法及结果判断。,Casestudy：,Onepatienthasgotpenicillinskintest5minbefore,nowhesuddenlyfeelschesttightness,shortnessofbreathwithpale,coldsweat,hisbloodpressureisat10/7.0Kpa(75/52mmHg),pulseisweak.Whatisthisphenomenon?Howdoyoumanageitifyouareanurseonduty？.,MnagementofAllergicshock,Themostseverealergicreactionisalsocalledanaphylaxisoranaphylacticshock,1.stopmedicine.2.give0.1%adrenaline(epinephrine)viasubcutaneousinjection.3.oxygeninhalation.4.anti-allergy5.correctionofacidosis.6.expandbloodvolume.7.resuscitation.8.closeobservationofdiseaseThesoonerthatepinephrineisgiven,thegreaterthechanceforsurvival,过敏反应的处理,过敏反应的处理,Thetreatmentonanaphylacticshockmustbeprompt,graspeveryminuteandsecond,startrescuewithoumoving,adopteffectivemeasuresandcloseobservation,Havethepersonlieflat,raisehisfeet,andcoverhimorherwithawarmblanket.giveoxygen,Giveinjectionof0.1%epinephrine0.51mlatonceIfsymptomsisnotremission,give0.1%epinephrine0.5mleveryhalfhour.Ifcardiacarrestisoccurred,startCPRimmediately,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滑肌等作用,Giveoxygentoimprovehypoxia.conductmouth-to-mouthartificialrespirationifRespiratoryarrest,giverespiratorystimulantNikethamide,lobelineviaintramuscularinjection,asphyxiainducedbyLaryngealedema,shouldperformendotrachealintubationortracheotomyandconnectartificialrespiratorassoonaspossible,Antiallergytreatment.Givedexamethasone510mgorhydrocortisonesodiumsuccinate200400mgin5%10%glucosesolution500mlviaintravenousinfusion,Giveantihistaminedrugs,promethazinehydrochloride2550mgordiphenhydramine40mgviaintramuscularinjections,Giveintravenousinfusionof10%dextroseorRingerssolution.accordingtodoctorsordersgivedopamineornorepinephrineviaintrvenousinfusion,Correctionofacidosis,AcupunctureofNeiguanZusanli,CloseobservationandrecordingV/S,urinaryoutput,consciousness.Donotmovepatientbeforeheisnotoutofdanger,Evaluatetreatmenteffect,andprovidethebasisforfurthermanagement,发生机制,青霉素,皮肤、消化道、呼吸道症状及过敏性休克等,青霉素过敏反应,青霉素过敏反应的预防,family幻灯片11,alergic,medication,alergictest,Accuratetestsolution,Strictlymastermethod,Correctlyjudgresults,现用现配药液,每次注射后观察半小时,做好急救的准备,减少青霉稀酸的产生,防止过敏反应的发生;防止青霉素水溶液的效价在室温中下降,影响治疗效果,N:Mr.Zhao,youhavegotpneumonia.Wellgiveyousomepenicillininjections.First,Illgiveyouapenicillinallergytest.Haveyouusedpenicillinbefore?P:Yes,Ihave.N:Areyouallergictoit?P:No,never.N:Isthereanybodyelseinyourfamilyallergictoit?P:Ithinkthereisnobody.N:Areyouallergictoanyotherdrugs?P:No.,1.Allergicshock2.Serumsicknessreaction3.Theallergicreactionoftheorganortissue,clincalmenifastation,过敏性休克,青霉素过敏性休克属型变态反应，发生率约为510个/1万,特点是危险性大、一般呈闪电样发生，5%患者于给药后5分钟内出现症状，10%出现于半小时以后，既可发生于皮内试验过程中，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,clincalmenifastationofallergicshock,呼吸道阻塞症状循环衰竭症状中枢神经系统症状其它过敏反应,呼吸道阻塞症状,由于喉头水肿支气管痉挛肺水肿所引起,ChesttightnessShortnessofbreathAsthmaDyspnea,循环衰竭症状,由于周围血管扩张导致有效循环血量不足,PaleColdsweatCyanosisWeakpulseAdropinbloodpressure,中枢神经系统症状,因脑组织缺氧所致,DizzylimbsnumbnessLossofconsciousnessTwitchIncontinentofurineandbowel,其它过敏反应,Urticarianauseavomitingabdominalpaindiarrheafever,serumsickness-likereaction,于用药后714天出现，临床表现与血清病相似，Fever,Jointswellingandpain,Itchyskin,Urticaria,Generalizedlymphadenopathyabdominalpain,各器官或组织的过敏反应,皮肤过敏反应瘙痒荨麻疹严重者发生剥脱性皮炎,呼吸道过敏反应可引起哮喘或促发原有的哮喘发作,消化道过敏反应可引起过敏性紫癜以腹痛和便血为主要症状,青霉素过敏试验法,试液标准,配制方法,试验方法,结果判断,200500u/1ml,一次溶解，三次稀释,遵照皮内注射方法进行,皮试液配制方法,青霉素80万u+N.S4ml=20万u/ml,吸0.1ml+N.S至1ml=2万u/ml(弃去.ml),余0.1ml+N.S至1ml=2000u/ml(弃去.ml),余0.1ml+N.S至1ml=200u/ml,皮肤试验结果的判断,negtive（-）postive（+）,皮丘无改变周围不红肿无红晕无自觉症状,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,redeyes,几种常用药物过敏试验法,链霉素过敏试验法,配制方法,链霉素100万u+N.S3.5ml=25万u/ml,吸0.1ml+N.S至1ml=2.5万u/ml(弃去.ml),余0.1ml+N.S至1ml=2500u/ml,一次溶解二次稀释,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（tetanusantitoxin,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：15IU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。阳性需采用脱敏注射法。,脱敏注射法,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,Desensitizationinjection,timeTATN.Smethod,10.1ml0.9ml20.2ml0.8mlIM30.3ml0.7ml4余量至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.