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1、药物过敏试验及过敏反应的处理Medicationallergytestandmanagementofallergicreaction,TracyZhao,Content,Penicillin allergy test Streptomycin allergy test Tetanus allergy test Cephalosporin allergy test Iodine allergy test Procaine allergy test,学习目标,掌握青霉素过敏试验方法、结果判断、过敏反应的临床表现、预防和急救处理原则。掌握TAT脱敏注射法。熟悉青霉素过敏反应的原因。熟悉链霉素、破伤风
2、抗毒素、普鲁卡因、碘过敏试验的方法及结果判断。,Case study：,One patient has got penicillin skin test 5min before,now he suddenly feels chest tightness,shortness of breath with pale,cold sweat,his blood pressure is at 10/7.0Kpa(75/52mmHg),pulse is weak.What is this phenomenon?How do you manage it if you are a nurse on duty？
3、.,Mnagement of Allergic shock,The most severe alergic reaction is also called anaphylaxis or anaphylactic shock,1.stop medicine.2.give 0.1%adrenaline(epinephrine)via subcutaneous injection.3.oxygen inhalation.4.anti-allergy5.correction of acidosis.6.expand blood volume.7.resuscitation.8.close observ
4、ation of diseaseThe sooner that epinephrine is given,the greater the chance for survival,过敏反应的处理,过敏反应的处理,The treatment on anaphylactic shock must be prompt,grasp every minute and second,start rescue withou moving,adopt effective measures and close observation,Have the person lie flat,raise his feet,
5、and cover him or her with a warm blanket.give oxygen,Give injection of 0.1%epinephrine 0.5 1ml at onceIf symptoms is not remission,give 0.1%epinephrine 0.5ml every half hour.If cardiac arrest is occurred,start CPR immediately,肾上腺素是抢救过敏性休克的首选药物，具有收缩血管、增加外周阻力、提升血压、兴奋心肌、增加心输出量以及松弛支气管平滑肌等作用,Give oxygen
6、to improve hypoxia.conduct mouth-to-mouth artificial respiration if Respiratory arrest,give respiratory stimulant Nikethamide,lobelinevia intramuscular injection,asphyxia induced by Laryngeal edema,should perform endotracheal intubation or tracheotomy and connect artificial respiratoras soon as poss
7、ible,Anti allergy treatment.Give dexamethasone 5 10mg or hydrocortisone sodium succinate 200 400mg in 5%10%glucose solution 500ml via intravenous infusion,Give antihistamine drugs,promethazine hydrochloride 25 50mg or diphenhydramine 40mg via intramuscular injections,Give intravenous infusion of 10%
8、dextrose or Ringers solution.according to doctors orders give dopamine or norepinephrine via intrvenous infusion,Correction of acidosis,Acupuncture of Neiguan Zusanli,Close observation and recording V/S,urinary output,consciousness.Do not move patient before he is not out of danger,Evaluate treatmen
9、t effect,and provide the basis for further management,发生机制,青霉素,皮肤、消化道、呼吸道症状及过敏性休克等,青霉素过敏反应,青霉素过敏反应的预防,family幻灯片 11,alergic,medication,alergic test,Accurate test solution,Strictly master method,Correctly judg results,现用现配药液,每次注射后观察半小时,做好急救的准备,减少青霉稀酸的产生,防止过敏反应的发生;防止青霉素水溶液的效价在室温中下降,影响治疗效果,N:Mr.Zhao,you
10、 have got pneumonia.Well give you some penicillin injections.First,Ill give you a penicillin allergy test.Have you used penicillin before?P:Yes,I have.N:Are you allergic to it?P:No,never.N:Is there anybody else in your family allergic to it?P:I think there is nobody.N:Are you allergic to any other d
11、rugs?P:No.,1.Allergic shock2.Serum sickness reaction3.The allergic reaction of the organ or tissue,clincal menifastation,过敏性休克,青霉素过敏性休克属型变态反应，发生率约为510个/1万,特点是危险性大、一般呈闪电样发生，5%患者于给药后5分钟内出现症状，10%出现于半小时以后，既可发生于皮内试验过程中，也可发生于初次注射时，也有极少数患者发生于连续用药的过程中,clincal menifastation of allergic shock,呼吸道阻塞症状 循环衰竭症状 中
12、枢神经系统症状 其它过敏反应,呼吸道阻塞症状,由于喉头水肿支气管痉挛肺水肿所引起,Chest tightnessShortness of breathAsthmaDyspnea,循环衰竭症状,由于周围血管扩张导致有效循环血量不足,PaleCold sweatCyanosisWeak pulseA drop in blood pressure,中枢神经系统症状,因脑组织缺氧所致,Dizzy limbs numbness Loss of consciousnessTwitch Incontinent of urine and bowel,其它过敏反应,Urticarianauseavomiting
13、abdominal pain diarrhea fever,serum sickness-like reaction,于用药后714天出现，临床表现与血清病相似，Fever,Joint swelling and pain,Itchy skin,Urticaria,Generalized lymphadenopathy abdominal pain,各器官或组织的过敏反应,皮肤过敏反应 瘙痒荨麻疹严重者发生剥脱性皮炎,呼吸道过敏反应 可引起哮喘或促发原有的哮喘发作,消化道过敏反应 可引起过敏性紫癜以腹痛和便血为主要症状,青霉素过敏试验法,试液标准,配制方法,试验方法,结果判断,200500u/1
14、 ml,一次溶解，三次稀释,遵照皮内注射方法进行,皮试液配制方法,青霉素 80万u+N.S 4ml=20万u/ml,吸 0.1ml+N.S至1ml=2万u/ml(弃去.ml),余 0.1ml+N.S至1ml=2000u/ml(弃去.ml),余0.1ml+N.S 至1ml=200u/ml,皮肤试验结果的判断,negtive（-）postive（+）,皮丘无改变周围不红肿无红晕无自觉症状,皮丘隆起增大出现红晕直径大于1cm周围有伪足伴局部痒感严重时可有头晕心慌、恶心甚至发生过敏性休克,Watery,red eyes,几种常用药物过敏试验法,链霉素过敏试验法,配制方法,链霉素100万u+N.S 3.
15、5ml=25万u/ml,吸 0.1ml+N.S至1ml=2.5万u/ml(弃去.ml),余0.1ml+N.S 至1ml=2500u/ml,一次溶解二次稀释,三、破伤风抗毒素过敏反应试验及脱敏注射法,破伤风抗毒素（tetanus antitoxin,TAT)是马的免疫血清，对人体是一种异种蛋白，具有抗原性，注射射后易出现过敏反应。TAT引起过敏反应率5%30%，其中有约十万分之一的致死率。用过TAT超过1周者，如需再用，应重做过敏试验。,（一）过敏试验法1、试验液的配制2、试验方法 剂量：15 IU 时间：20分钟 结果判断：阴性：局部无红肿、无异常全身反应。阳性：皮丘红肿，硬结直径大于1.5c
16、m，红晕范围直径超过4cm，有时出现伪足或有痒感。全身反应以血清病型反应多见。处理：阴性可把所需剂量一次注射完。阳性需采用脱敏注射法。,脱敏注射法,脱敏注射法是将所需TAT剂量,分多次少剂量间隔20min密切观察下注射到患者体内,Desensitization injection,time TAT N.S method,1 0.1ml 0.9ml 2 0.2ml 0.8ml I M 3 0.3ml 0.7ml 4 余量 至1ml,四、普鲁卡因与碘过敏试验,（一）普鲁卡因过敏试验1、过敏试验方法 剂量：0.25%普鲁卡因0.1ml（25mg）2、结果判断和处理同青霉素。,（二）碘过敏试验1、过敏试验方法（1）口服法：5%10%碘化钾5ml，tid3天（2）皮内注射法：造影剂0.1ml ID。（3）静脉注射法：造影剂1ml IV。2、结果判断（1）口服法：口麻、头晕、心慌、荨麻疹等。（2）皮内注射法：局部红肿硬结1cm。（3）静脉注射法：有血压、脉搏、呼吸等改变。,任务单 请将一只80万u的青霉素配制成500 uml的青霉素皮试液？,学好护理学基础是我们共同的 愿!,Thank You!,
