最后审阅: 19 九月 2021
最后更新: 08 七月 2021
08 Jul 2021

关于全身过敏反应紧急治疗的最新英国指南

英国复苏委员会(Resuscitation Council UK)已发布其全身过敏反应紧急治疗指南的更新版(2021 年 5 月)。新的或修订的建议包括以下内容:

不再建议将皮质类固醇(例如,氢化可的松)用于全身过敏反应的常规紧急治疗。

  • 可考虑在初始复苏后针对难治性反应、持续的哮喘或休克给予皮质类固醇治疗。请勿优先于肾上腺素给予皮质类固醇。

如今推荐在患者情况稳定后优先给予非镇静口服抗组胺药(例如,西替利嗪),而不是氯苯那敏,后者会导致镇静,尤其对于持续存在皮肤症状(荨麻疹和/或血管性水肿)的患者。

  • 抗组胺药被视为三线治疗,不应用于治疗初始紧急处理期间的气道/呼吸/循环问题。

对于难治性全身过敏反应,建议静脉输液,并且在出现低血压或休克时必须尽早给予。

按如下方式监测有无双相反应(这取代了 NICE 对 16 岁以上患者在症状出现后监测 6-12 小时的指导):

  • 如果存在以下情况,在症状消退后监测至少 2 小时(考虑快速通道出院):

    • 对在反应发作 30 分钟内给予的单剂肾上腺素反应良好,并且

    • 症状完全消退,并且

    • 患者有未使用过的肾上腺素,并且接受过使用方法的培训,并且

    • 在出院后有充分的监管

  • 如果已肌内注射两剂肾上腺素或既往发生过双相反应,则在症状消退后观察至少 6 小时。

  • 对于具有以下情况的患者,在症状消退后观察至少 12 小时:

    • 需要>2 剂肾上腺素治疗的严重反应

    • 重度哮喘或涉及严重呼吸功能损害的反应

    • 存在持续吸收变应原的可能性(例如,缓释药物)

    • 深夜发病

    • 可能无法应对恶化

    • 难以获得紧急救护。

查看治疗:治疗路径

查看治疗:治疗流程

更新原始来源external link opens in a new window

小结

定义

病史和体格检查

关键诊断因素

  • 急性发作
  • 气道肿胀(血管性水肿)
  • 吸气相鸣音和声音嘶哑
  • 呼吸短促
  • 喘息、胸部过度充气和辅助呼吸肌参与呼吸
  • 紫绀
  • 呼吸骤停
  • 面色苍白、皮肤湿冷
  • 低血压
  • 脉率增加(心动过速)
  • 心动过缓
  • 心搏骤停
  • 意识模糊或定向障碍
  • 荨麻疹(风团)
  • 红斑
  • 瘙痒
  • 血管性水肿
  • 鼻炎
  • 双侧结膜炎

其他诊断因素

  • 危险因素
  • 恶心、呕吐、腹泻和失禁
  • 腹部绞痛和疼痛
  • 激越、焦虑和感到在劫难逃(死亡恐怖)

危险因素

  • 成年:食物、昆虫毒素及药物相关
  • 30 岁以下人群:食物相关运动诱发
  • 女性
  • 特应性疾病/哮喘
  • 全身过敏反应既往史
  • 接触常见致敏物(例如乳胶)

诊断性检查

首要检查

  • 肥大细胞类胰蛋白酶
  • 12 导联心电图
  • 尿素和电解质
  • 动脉血气分析

治疗流程

撰稿人

专家顾问

Alexander Alexiou, MB BS BSc DCH FRCEM Dip IMC RCSEd

Flight Doctor

Greater Sydney Area Helicopter Emergency Medical Service

Sydney

New South Wales

Australia

利益声明

AA declares that he has no competing interests.

Thomas Palmer, BSc MBChB FRCEM

ST6 Emergency Medicine

Royal London Hospital

London

UK

利益声明

TP declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:

Doerthe Adriana Andreae MD

Assistant Professor

Pediatric Allergy and Immunology

Penn State Health Milton S. Hershey Medical Center

Hershey

PA

Michael Henning Andreae MD

Associate Professor

Department of Anesthesiology

Penn State Health Milton S. Hershey Medical Center

Hershey

PA

利益声明

DAA is author of an UpToDate article on food allergy and a number of references cited in this topic. MHA is an author of a reference cited in this topic.

同行评议者

Robert Taylor, MBChB MRCP(UK) MRCP(London) DipMedTox DipTher PGDME FHEA FRCEM

Acute Hospital Sub Dean (Cornwall)

Honorary Clinical Senior Lecturer

Consultant Emergency Physician

The Knowledge Spa

Royal Cornwall Hospital

Truro

UK

利益声明

RT declares that he has no competing interests.

编辑

Celia Pincus,

Section Editor, BMJ Best Practice

利益声明

CP declares that she has no competing interests.

Susan Mayor,

Lead Section Editor, BMJ Best Practice

利益声明

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

利益声明

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

内容使用需遵循免责声明