1例艾司氯胺酮致围产期过敏性休克的病例分析

王良芬; 何梦婕; 刘嫚; 赵玥

doi:10.6039/j.issn.1001-0408.2024.18.19

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1例艾司氯胺酮致围产期过敏性休克的病例分析

药师与药学服务 | 更新时间：2024-09-25

- 1例艾司氯胺酮致围产期过敏性休克的病例分析
- Analysis of a case of perinatal anaphylactic shock caused by esketamine
- 中国药房 2024年35卷第18期页码：2299-2303
- 作者机构：
  
  1.四川省妇幼保健院临床药学科，成都　610041
  2.三六三医院药剂科，成都　611730
  3.成都高新中和中医医院药剂科，成都　610059
- 作者简介：
  
  主管药师，博士。研究方向：抗感染及妇产方向临床药学。电话：028-63800158。E-mail：348718577@qq.com
  副主任药师，硕士。研究方向：妇产方向临床药学。电话：028-65978526。E-mail：49256310@qq.com
- 基金信息：
  
  国家卫生健康委医院管理研究所医院药学高质量发展研究项目(NIHAYS2301)
- DOI：10.6039/j.issn.1001-0408.2024.18.19
  中图分类号： R969.3;R392.8
- 纸质出版日期：2024-09-30，
  
  收稿日期：2024-03-06，
  
  修回日期：2024-06-26，
- 稿件说明：
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王良芬,何梦婕,刘嫚等.1例艾司氯胺酮致围产期过敏性休克的病例分析 ^Δ[J].中国药房,2024,35(18):2299-2303.

WANG Liangfen,HE Mengjie,LIU Man,et al.Analysis of a case of perinatal anaphylactic shock caused by esketamine[J].ZHONGGUO YAOFANG,2024,35(18):2299-2303.
王良芬,何梦婕,刘嫚等.1例艾司氯胺酮致围产期过敏性休克的病例分析 ^Δ[J].中国药房,2024,35(18):2299-2303. DOI： 10.6039/j.issn.1001-0408.2024.18.19.

WANG Liangfen,HE Mengjie,LIU Man,et al.Analysis of a case of perinatal anaphylactic shock caused by esketamine[J].ZHONGGUO YAOFANG,2024,35(18):2299-2303. DOI： 10.6039/j.issn.1001-0408.2024.18.19.

摘要

目的

为临床工作者及时识别和治疗围产期过敏性休克提供参考。

方法

临床药师参与四川省妇幼保健院产科1例足月妊娠患者剖宫产麻醉中使用艾司氯胺酮致过敏性休克的救治过程，通过查阅药品说明书并检索相关文献，协助医师对过敏性休克与羊水栓塞进行区分鉴别，对所用药物与不良反应的关联性进行分析，并进行用药教育。

结果

该患者麻醉后出现低氧血症和低血压，且不存在凝血功能障碍，经肾上腺素对症处理后快速好转，故诊断为过敏性休克。根据该患者用药情况、不良反应发生特点，结合国家药品不良反应监测中心药物与不良反应关联性判定标准和Naranjo’s评估量表，综合判定引起过敏性休克的可疑致敏药物为艾司氯胺酮；临床药师告知患者后期就诊时务必告知医师此次严重过敏反应的相关药物。患者于剖宫产术后第6天痊愈出院。

结论

过敏性休克与羊水栓塞的临床表现相似，临床需要仔细鉴别。若患者发生了药物导致的全身过敏反应，临床应及时停用可疑药物，并立即采取有效的对症治疗措施，延缓或终止疾病进展，以保障患者的生命安全。

Abstract

OBJECTIVE

To provide a reference for medical staff to timely identify and treat perinatal anaphylactic shock.

METHODS

The clinical pharmacists participated in the rescue process of anaphylactic shock caused by esketamine during cesarean section anesthesia in a full-term pregnant patient at the Department of Obstetrics and Gynecology of Sichuan Provincial Maternity and Child Health Care Hospital. By consulting the relevant drug instructions and searching the relevant literature， clinical pharmacists assisted physicians in identifying anaphylactic shock and amniotic fluid embolism， analyzing the correlation between the drugs used and adverse reactions， and providing medication education.

RESULTS

The patient developed hypoxemia and hypotension after anesthesia， and there was no coagulation dysfunction. After symptomatic treatment with adrenaline， the condition rapidly improved， so it was diagnosed as anaphylactic shock. Based on the patient’s medication use and the characteristics of adverse reactions， combined with the National Adverse Drug Reaction Monitoring Center’s criteria for determining the association between drugs and adverse reactions and Naranjo’s evaluation scale， it was comprehensively determined that the suspected allergenic drug causing anaphylactic shock was esketamine. The clinical pharmacist informed the patient that she must inform the physician of the relevant medications for this severe allergic reaction during her later visits. The patient recovered and was discharged on the 6th day after cesarean section.

CONCLUSIONS

The clinical manifestations of anaphylactic shock and amniotic fluid embolism are similar， and careful differentiation is needed in clinical practice； if a patient experiences a systemic allergic reaction caused by drugs， the suspected drugs should be stopped promptly and effective symptomatic treatment should be taken immediately to delay or terminate disease progression and ensure the patient’s life safety.

关键词

艾司氯胺酮过敏性休克围产期麻醉药物

Keywords

anaphylactic shockperinatal periodnarcotic drugs

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