鱼精蛋白过敏反应2例
ACTA AACADEMIAE MEDICINAE QINGDAO UNIVERSITATIS(2010)
Abstract
例1,男,46岁,因全身乏力1月,少尿伴胸闷、憋气3 d急症入院.查体:BP 23.9411.97 kPa,贫血貌,强迫体位,双下肢凹陷性水肿,双肺湿啰音.心率50 min-1,律整.急查血清钾8.5 mmolL,血肌酐907 μmolL,Hb 60 gL.心电图检查:Ⅰ度房室传导阻滞,T波高尖.诊断:慢性肾衰竭(尿毒症期),高钾血症.入院后遵医嘱进行透析治疗.透析前15 min首量用普通肝素20 mg,并每小时追加8 mg.因病人为首次透析,血肌酐过高,为避免应激性出血,下机前给予鱼精蛋白25 mg加生理盐水20 mL缓慢静脉推注.约5 min,鱼精蛋白推注量10 mg时,病人出现红疹、皮肤瘙痒,考虑为鱼精蛋白过敏所致.即刻停用鱼精蛋白,给予地塞米松5 mg静脉推注,葡萄糖酸钙10 mL 稀释后缓慢静脉推注.约20 min后,病人红疹减少,瘙痒减轻,1 h后症状消失.
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