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皮肤病

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刚给严重超敏反应患者肌注了肾上腺素,还需要观察多久?
原作者: Feras Khan,李辉 翻译,肖锋 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2014-09-11

Title: I just gave IM Epi for anaphylaxis, how long do I need to observe the patient?
题目:刚给严重超敏反应患者肌注了肾上腺素,还需要观察多久?
Author 作者: Feras Khan
翻译:李辉 校对:肖 锋

Background 背景:
•Common practice is to observe patients who receive epinephrine for allergic reactions or anaphylaxis for several hours post-administration
•对于因过敏反应或严重超敏反应接受肾上腺素治疗的患者通常的做法就是在接受治疗后观察数小时。
•This can be from 4-24 hours depending on the institution
•根据医疗机构的差异,这一时间可以在4-24小时。
•This is to monitor for a biphasic reaction
•这是为了观察过敏的双期反应。

Question 问题:
•Do we need to observe these patients?
•我们需要观察这些患者吗?
•And if so, for how long?
•如果需要,多长时间呢?

Meta-analysis Meta分析:
•2 urban Canadian EDs
•2个加拿大市区的急诊科
•5 year period
•5年的时间
•Primary outcome was the amount of patients with a clinically important biphasic reaction
•主要的结果是患者临床上出现重要双期反应的数量
•Secondary outcome was mortality
•次要的结果是死亡率

Results 结果:
•2819 encounters: 496 anaphylactic + 2323 allergic reactions
•2819 例:496例严重超敏反应+2323例过敏反应
•5 clinically important biphasic reactions (0.18%; 95% CI 0% to 0.17%)
•5例临床表现严重的双期反应(0.18%; 95% CI 0% to 0.17%)
•No fatalities
•没有死亡病例
•Biphasic reactions tended to happen several hours (>24hrs) after ED discharge
•双期反应倾向于在离开急诊室后数小时(>24hrs)后发生

Limitations 不足:
•If patients did not return to an ED in the region, then they would not be identified as a possible biphasic reaction
•如果患者没有返回这个地区的急诊科,他们不会被视为一个可疑的双期反应病例。

What to do? 该做什么呢?
•You can probably discharge most patients whose symptoms have resolved without a prolonged observation period (<4hrs)
•你可以让多数症状消失的患者回家,无需长时间的观察(<4小时)
•Patients with ongoing anaphylaxis and allergic reaction, should be observed longer or admitted
•患者表现为持续的严重超敏反应及过敏反应,需要观察更长时间或收治住院。
•Biphasic reactions are very rare
•双期反应是极为罕见的。

References 参考文献:
Grunau B, et al. Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients with Allergic Reactions or Anaphylaxis. Annals of Emergency Medicine. Vol 63, No 6; June 2014 736-743. 

文章来源:《中华急诊医学杂志》编辑部