肾上腺素救治过敏性休克使用方法调查分析

Investigation and Analysis on the Usage Method of Adrenaline in the Treatment of Anaphylactic Shock

关键词:  肾上腺素  过敏性休克  急救  使用方法

Key words:  adrenaline  anaphylactic shock  first aid  usage method

摘要:

目的 调查分析肾上腺素救治过敏性休克的使用方法。方法 关于过敏性休克发生时肾上腺素的注射方法和注射剂量对临床医护人员进行问卷调查，结合肾上腺素药品说明书、《严重过敏反应急救指南》和《围术期过敏反应诊治的专家共识》等相关临床指南共识和文献资料，分析探讨了肾上腺素用于过敏性休克急救时的给药方法。结果 研究结果显示，临床在使用肾上腺素救治过敏性休克时，34%临床医师和42%护士首选皮下注射给药；20%临床医师和30%护士首选肌内注射给药；选择肾上腺素注射液稀释后静脉注射的临床医师和护士分别为20%和16%；而选择药液不稀释直接静脉注射的临床医师和护士占比分别为26%和12%。70%临床医师和76%护士认为肾上腺素的单次使用剂量以0.5~1.0 mg为宜。依据相关指南和文献资料，患者在发生过敏性休克反应时，肾上腺素肌内注射给药方便及时，药物吸收速率较皮下注射快，起效迅速，风险小，单次注射剂量以0.3~0.5 mg为宜，是首先推荐的用药方法。肾上腺素不经稀释直接静脉注射，可能会导致患者血压急剧升高，引发心律失常和脑血管意外。结论 应加强临床合理用药培训，在救治过敏性休克时，选择肾上腺素安全有效的给药方法，促进肾上腺素的规范合理使用。

Abstract:

OBJECTIVE To investigate and analyze the use of adrenaline in the treatment of anaphylactic shock. METHODS Investigated the injection method and the dose of the adrenaline for treatment of the anaphylactic shock by questionnaire survey on clinical staff. Combined with the relevant clinical guidelines, consensus and literatures such as the adrenaline drug instruction, "First Aid Guide on Severe Allergic Response" and "Experts Consensus on Diagnosis and Treatment of Perioperative Allergic Reaction" etc, the application of adrenaline in the first aid for anaphylactic shock was discussed. RESULTS The results of the study showed that 34% of clinicians and 42% of nurses were advised to use subcutaneous injection when using adrenaline to treat anaphylactic shock in clinic; 20% of clinicians and 30% of nurses thought that intramuscular injection should be preferred. The number of clinicians and nurses who received intravenous injections after diluting adrenaline injections was 20% and 16%, respectively, while the proportion of clinicians and nurses who chose direct intravenous injection without diluting was 26% and 12%, respectively; 70% of clinicians and 76% of nurses believed that a single dose of adrenaline was preferably 0.5 to 1.0 mg. According to the relevant guidelines and literatures, the intramuscular injection of adrenaline was convenient and timely when the anaphylactic shock reaction occurs. It also had a faster absorption rate and a lower risk. It was the first recommended method of administration with a dose of 0.3-0.5 mg. However, adrenaline was directly injected intravenously without dilution, which might cause a sharp rise in blood pressure of the patient, and it might induce arrhythmia and cerebrovascular accident. CONCLUSION It is necessary to strengthen training of rational drug use. In the treatment of anaphylactic shock, a safe and effective administration of adrenaline injection should be selected to promote its rational use.