目的：分析1 例皮试阴性的先兆早产患者使用头孢唑林致过敏性休克的发生和处理过程,为临床患者,尤其是孕妇的用药安全提供参考。方法与结果：患者（女,26 岁）因“停经 36 周,阴道流水 3 h”来院治疗,查体示其胎膜已破,为预防无乳链球菌感染,遂预防性予头孢唑林（皮试阴性）;然而,静脉滴注 30 s 后,患者出现手脚发麻、胸闷、憋气、呼吸困难、呕吐、全身皮肤发绀等过敏性休克症状,遂立即停用头孢唑林,并就地抢救;其间,胎心率由 110 次/min 降至 60~80 次/min,考虑胎儿窘迫,遂立即行剖宫产分娩;之后,新生儿和产妇分别转至儿科和 ICU 救治,数日后新生儿和产妇均康复出院;事后,根据药物不良反应关联性评价标准,头孢唑林与过敏性休克的关联性为“很可能”。结论：头孢唑林作为一种安全性较高的抗菌药物,很少引起如过敏性休克这样严重的药物不良反应,但其用药风险仍然存在,对此临床仍须做好用药安全监测,尤其是孕产妇这样的特殊群体,从而保证患者的用药安全。
Abstract
Objective: To analyze the occurrence and treatment process of allergic shock induced by cefazolin in a patient with threatened premature labor and negative skin test, and provide reference for clinical medication safety of patients, particularly pregnant women. Methods and Results: :The patient (female, 26 years old) was hospitallized due to "36 weeks of gestation and 3 hours of vaginal leakage". The physical examination revealed fetal membrane rupture. To prevent infection with Streptococcus agalactiae, cefazolin was prophylactically administered (negative skin test). However, after intravenous infusion for 30 seconds, the patient developed symptoms of allergic shock, including numbness in hands and feet, chest tightness, shortness of breath, difficult breathing, vomiting, and cyanosis. Cefazolin was immediately discontinued, and emergency resuscitation was initiated. During this period, the fetal heart rate dropped from 110 beats per minute to 60-80 beats per minute, indicating fetal distress, and the cesarean section was performed immediately. Subsequently, the newborn and the mother were transferred to the pediatric department and ICU separately for further treatment. Several days later, both the newborn and the mother fully recovered and were discharged. Following the event, based on the evaluation criterion for adverse drug reaction association, the association between cefazolin and allergic shock was considered "highly likely". Conclusion: Although cefazolin is considered a relatively safe antibacterial drug and rarely causes severe adverse drug reactions like allergic shock, its medication risk remains. Therefore, clinical medication safety should be monitored, especially for special populations such as pregnant women, so as to ensure the medication safety for patients.
关键词
头孢唑林 /
先兆早产 /
过敏性休克 /
药物不良反应
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Key words
cefazolin /
threatened premature labor /
allergic shock /
adverse drug reaction
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参考文献
[1] Elkomy MH, Sultan P, Drover DR, et al.Pharmacokinetics of prophylactic cefazolin in parturients undergoing cesarean delivery[J].Antimicrob Agents Chemother, 2014, 58(6): 3504-3513.
[2] Li J, Echevarria KL, Hughes DW, et al.Comparison of cefazolin versus oxacillin for treatment of complicated bacteremia caused by methicillin-susceptible Staphylococcus aureus[J].Antimicrob Agents Chemother, 2014, 58(9): 5117-5124.
[3] Eljaaly K, Alshehri S, Erstad BL.Systematic review and meta-analysis of the safety of antistaphylococcal penicillins compared to cefazolin[J].Antimicrob Agents Chemother, 2018, 62(4): e01816-e01817.
[4] 中华医学会妇产科学分会产科学组. 胎膜早破的诊断与处理指南(2015)[J].中华妇产科杂志,2015,50(1):3-8.
[5] McCall SJ, Bunch KJ, Brocklehurst P, et al. The incidence, characteristics, management and outcomes of anaphylaxis in pregnancy: a population-based descriptive study[J].BJOG, 2018, 125(8): 965-971.
[6] 冉雨鑫,尹楠林,漆洪波. ACOG《胎膜早破临床实践指南(2020)》解读[J].中国实用妇科与产科杂志,2020,36(8):736-739.
[7] 国家卫生健康委.《药品不良反应报告和监测管理办法》(卫生部令81号)[A/OL].(2010-05-04)[2023-12-12].https://www.gov.cn/zhengce/2011-05/24/content_260339htm.
[8] 国家卫生健康委办公厅.关于印发β内酰胺类抗菌药物皮肤试验指导原则(2021 年版)的通知:国卫办医函〔2021〕 188 号[A/OL].(2021-04-13)[2023-12-12].http://www.nhc.gov.cn/yzygj/s7659/202104/a33f49b8c4b5421c85a5649a28a0fce2.shtml.
[9] Yang MS, Kang DY, Seo B, et al.Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: a large multicenter retrospective cohort study[J].Allergy, 2018, 73(9): 1833-1841.
[10] 张金红,房德敏,高颖,等. 头孢唑林钠皮试阴性致过敏性休克的系统文献分析[J].中国药学杂志,2019,54(12):1024-1030.
[11] 崔向丽,赵燕,赵志刚. 注射用头孢曲松钠致过敏性休克1例[J].中国药物警戒,2009,6(2):116-117.
[12] Brown AF.Anaphylactic shock: mechanisms and treatment[J].J Accid Emerg Med, 1995, 12(2): 89-100.
[13] Merchant RM, Topjian AA, Panchal AR, et al.Part 1: executive summary: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J].Circulation, 2020, 142(16_suppl_2): S337-S357.
[14] 李晓桐,翟所迪,王强,等. 《严重过敏反应急救指南》推荐意见[J].药物不良反应杂志,2019,21(2):85-91.
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