Dexamethasone is a kind of hormone drug, which has three functions: anti-inflammatory, anti-allergic and enhancing drug effect.
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Treatment experience of allergic shock caused by Qingkailing injection 1 case
Yufang Chen
Ada Outpatient Department of Taihe Hospital 442000.
The patient, a 34-year-old female, came to our hospital on August 8, 2000 for fever, cough, runny nose and sore throat for three days. The body temperature is 38℃, the pharynx is congested, bilateral tonsils are swollen, there is no pus thrombus, and the heart and lungs are normal. Diagnosed as upper respiratory tract infection. Intravenous injection of Qingkailing 30ml plus 5% glucose 250ml for treatment. 15 minutes later, the patient developed chills, shortness of breath, mild cyanosis, and his blood pressure was 88/58mmHg. He immediately slowed down the dripping speed, gave antiallergic treatment (promethazine 25mg intramuscular injection and dexamethasone 10mg intravenous injection) and oxygen inhalation, and observed the changes of his condition. After 5 ~ 10 min, the symptoms did not improve, but worsened. Chest tightness, dyspnea, cyanosis of face and chills of limbs appear. At this time, the heart rate 120 beats/min, breathing 32 beats/min, and blood pressure 50/30mmHg. Immediately change the fluid (sugar and salt, a lot of vitamin C), increase the oxygen flow, intravenous injection of 1mg epinephrine and adequate dexamethasone. After 5 ~ 10 min, the blood pressure rose to 95/72mmHg, and the general condition improved.
It is discussed that Qingkailing injection is a compound preparation of traditional Chinese medicine and a brown clear liquid. Its main functions are clearing away heat and toxic materials, removing blood stasis and dredging collaterals, resisting inflammation and virus. Mainly used for fever, upper respiratory tract infection, acute and chronic hepatitis. The usual dose for adults is 20 ~ 40ml, which is dissolved in 5% or 10% glucose solution for intravenous drip in 250~500ml. According to our application observation of more than 50 cases in more than two years, there are almost no adverse reactions in clinic, and there is no report in domestic literature after retrieval. Through the treatment of this patient, the author has the following experience: Before taking 1, carefully ask about the history of drug allergy, and patients with allergic history should use it with caution. The optimal dilution concentration of intravenous drip should be above 1: 10, and the speed should not be too fast, especially for the first injection. Try not to use it with other drugs. 4 Do not use the existing turbidity and precipitation. 5. During the medication, closely observe the adverse reactions of patients, especially within 30 minutes of medication. Once allergic reaction occurs, stop taking medicine immediately and carry out desensitization treatment in time. For patients with severe allergic reaction and anaphylactic shock, epinephrine and adequate glucocorticoid should be used early, and the observation of vital signs should be strengthened.
(Chen Yufang: Nurse)
(Date of receipt: 2000- 10-20) (Editor: Xu Daguo)
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The main components of Qingkailing injection are extracts of Calculus Bovis, Cornu Bubali, Flos Lonicerae, Scutellariae Radix, Fructus Gardeniae, etc. Has the effects of clearing away heat and toxic materials, resolving phlegm, dredging collaterals, and awakening consciousness; It also has antibacterial, antifungal and antiviral effects. Calculus Bovis has sedative, antipyretic, anti-inflammatory, respiratory stimulating and red blood cell regeneration promoting effects, while Scutellaria baicalensis Georgi, Gardenia jasminoides Ellis and Lonicera japonica Thunb have broad-spectrum anti-inflammatory effects. Clinically, it is widely used to treat fever, stroke hemiplegia, upper respiratory tract infection, pneumonia, high fever and other diseases. However, there are reports of adverse reactions in clinical medication, and there is no mention of adverse reactions in the instructions. Therefore, when using Qingkailing injection in clinic, our medical workers should know the possible adverse reactions and countermeasures, so as to use drugs safely and reasonably and reduce the occurrence of adverse reactions. Adverse reactions, prevention and nursing measures are summarized as follows.
1 type of adverse reaction
According to 1995-2002 CD-ROM literature retrieval, the reports of adverse reactions of Qingkailing injection mainly include the following adverse reactions.
1. 1 Anaphylactic shock is mostly caused by upper respiratory tract infection with fever. After intravenous drip, anaphylactic shock [1] occurs as early as1minute and at the latest 30 minutes, which is characterized by pallor, chest tightness, shortness of breath, chills in limbs, increased heart rate and decreased blood pressure, and in severe cases, coma, limb convulsions and purple skin and mucosa. Even death [2, 3]. After drug withdrawal, anti-allergic and anti-shock treatment, the patient can return to normal after several minutes to 2 hours.
1.2 drug dermatitis Qingkailing injection can cause various drug dermatitis, such as urticaria-like drug eruption [4], measles-like drug eruption, scarlet fever-like drug eruption, and even bullous epidermolytic drug eruption [5] in severe cases. Rash mostly begins on the face and limbs, develops rapidly to the whole body, and can also be limited to the needle entry of forearm vein. Often accompanied by different degrees of skin itching, fever, facial flushing, eyelid conjunctival edema, breath holding, irritability, rapid heartbeat and other symptoms; Or scarlet fever-like lesions appear, which gradually increase and fuse into pieces to form papular herpes, which oozes and exfoliates after rupture. Dark red patches appear on the local skin, forming loose blisters of different sizes, and the epidermis is necrotic, which can fall off with a little friction, showing the performance of epidermolysis bullosa atrophic necrotizing dermatitis. The patient can return to normal after drug withdrawal and antiallergic treatment, and there is no pigmentation after the rash subsides.
1.3 The allergic reaction of laryngeal edema Qingkailing injection can be manifested as catarrhal mucosal reaction, and the main symptoms are sneezing, stuffy nose, throat discomfort, choking cough, hoarseness, limited tongue movement, unclear speech, dyspnea and loss of voice [6].
1.4 Gastrointestinal reactions were manifested as epigastric cold pain, belching, anorexia or persistent abdominal cramps; Unbearable abdominal distension, runny nose, nausea and vomiting, loose stool, etc. The symptoms gradually improved after drug withdrawal and symptomatic treatment [7].
1.5 sudden cyanosis of the lips, inability to lie down, shortness of breath, pink foam phlegm, dysphoria, wheezing in both lungs, moist rales at the bottom of both lungs, heart rate 16 beats/min, and dull heart sounds [8]. After drug withdrawal, cardiotonic, diuretic and antiallergic treatment for 65438±0h hours, the symptoms and signs disappeared.
Adverse reactions caused by intravenous drip 1.6 combined with penicillin have been reported. Qingkailing injection 20ml+ penicillin 8 million U combined infusion [9], after 30min minutes, the patient developed high fever of 465 438 0℃, irritability, convulsion and blood pressure drop. Immediately stop infusion rescue and return to normal. There were no adverse reactions after intravenous drip of the two drugs.
1.7 high fever caused by Qingkailing injection [10]. Due to intracranial infection, cerebral infarction, cold and sore throat and other symptoms, Qingkailing injection was intravenously dripped, causing chest tightness, speech difficulties, cough, and then chills, and the drug was stopped immediately. Symptoms disappeared after antiallergic treatment.
1.8 Mental symptoms caused by intravenous drip of Qingkailing injection, mental symptoms [1 1], irritability, nonsense, etc. The next day, Qingkailing was stopped and the symptoms disappeared.
2 Prevention and care
2. 1 Do a good job in health education and psychological care. Ask the patient's drug allergy history in detail before taking the medicine. For patients with a history of drug allergy, use drugs with caution. Do a good job in patients' health education and introduce the advantages and possible adverse symptoms of drugs. However, the possible discomfort should not be overemphasized before taking the medicine, especially for patients with mental stress. Once allergic symptoms appear, don't panic, appease the patient in time, do a good job of psychological care and explanation, and eliminate the panic of the patient.
2.2 Strengthen patrol and closely observe the blood transfusion reaction. The adverse reactions of Qingkailing mostly occur during the first infusion, with short incubation period, usually within 30 minutes after use, and the clinical manifestations can be varied. Therefore, in clinical nursing work, we should strengthen patrol and closely observe patients' reactions, especially for patients who are taking drugs for the first time and have a history of drug allergy, we should strictly control the dosage and infusion speed, and inform doctors in time if we find any changes and adverse reactions, stop taking drugs in time and give desensitization treatment. Patients with central nervous system diseases should pay close attention to the adverse reactions of the nervous system.
2.3 Pay attention to the incompatibility of drugs. When using Qingkailing in clinic, try not to use it with other drugs, especially with antibiotics. According to Wang Lianfen [12] and other reports, Qingkailing injection is incompatible with pituitrin injection, vitamin B 6 injection, gentamicin injection, calcium gluconate injection, magnesium sulfate injection, styptic aromatic acid injection, alamin injection, norepinephrine, isoproterenol and lobeline, so the operating procedures should be strictly observed in clinical operation. Qingkailing injection should not be used at the same time as contraindicated drugs. If necessary, direct contact between the two drugs should be avoided, and other liquids can be added in the middle. In the compatibility of new drugs, you should consult the information first. Before use, you should carefully check the clarity of the liquid medicine. If it is unclear and turbid after being mixed with the liquid medicine, do not use it to ensure the safety of patients and avoid adverse reactions. The best dilution concentration of Qingkailing injection for intravenous drip should be below 1 ~ 10 times, and it should be used now to avoid large dose. 1 day the dosage of Qingkailing injection increased to 3 ~ 5 times of the original dosage, and the incidence of chills, high fever, urticaria, angioneurotic edema and vascular diseases increased significantly [13].
3.4 Strengthen basic nursing, and timely and effectively give symptomatic treatment to the adverse reactions that have occurred. Once allergic reaction occurs, you should stop taking medicine immediately and give allergic symptomatic treatment. Oral chlorpheniramine and vitamin C, or intramuscular injection of diphenhydramine, chlorpheniramine, promethazine or intravenous injection of dexamethasone and 10% calcium gluconate. For patients with anaphylactic shock, oxygen inhalation, limb warming and anti-shock should be given in time, and adrenaline, dexamethasone, respiratory stimulants and antihypertensive drugs should be given for rescue treatment under the guidance of doctors. For those who are allergic to intestinal tract, 654-2 injection and Phenamin injection can be injected intramuscularly. Patients with acute left heart failure were given semi-sitting and lying position, oxygen inhalation, cardiotonic, diuretic and antiallergic treatment. Chilling, chills and other adverse reactions should be kept warm, those with chest tightness and shortness of breath should be given oxygen, and those with high fever should be cooled physically or with drugs. Patients with allergic dermatitis can be given topical dermatitis ointment or antiallergic drugs and glucocorticoid. Combined with acupuncture treatment of traditional Chinese medicine, such as selection of auricular acupuncture, Shenmen point and adrenal point, if severe cases are cured, good results can be achieved [14].
In a word, the advantages of Qingkailing injection outweigh the disadvantages in clinical application. As long as it can be used reasonably, and the patrol and observation are strengthened during and after medication, it can still be used with confidence.
refer to
1 liangye. Two cases of allergic shock caused by Qingkailing. Journal of Hengyang Medical College, 2000,9 (5): 28.
2 Hou, people. 1 case died of allergic reaction of Qingkailing injection. Medicine Guide, 2000,65,438+00,5 (65,438+09): 734.
3 Zhang Xiaohui, Xi Zengxin and Liao Jinglong. 2 cases died of allergic reaction of Qingkailing injection. China Hospital Pharmacy Journal, 200 1, 2 1 (5): 3 19.
More than 4 lighting. 3 cases of allergic urticaria caused by Qingkailing. New medicine,1999,30 (4): 991.
5 Xu, people. Epidermolysis bullosa atrophic necrotizing dermatitis caused by Qingkailing injection 1 case report. Ningxia Medical Journal, 2002,3 (24): 251.
6 Chen Shaoru, Zhang Peng. Acute laryngeal obstruction caused by Qingkailing injection 1 case. China Hospital Pharmacy Journal, 1996,16 (11): 525.
7 Tu Guifang. Two cases of skin allergy and intestinal allergy caused by Qingkailing injection. Journal of Gansu College of Traditional Chinese Medicine, 1995, 12( 1):35.
He shouzai Two cases of acute left heart failure caused by Qingkailing injection. Clinical summary, 1996, 1 1(2):90.
9 Ren Xiangxiang. 6 cases of adverse reactions caused by Qingkailing combined with penicillin intravenous drip. Journal of Intermediate Medicine,1995,30 (7): 45.
10 Wu qinghong 8 cases of drug fever caused by Qingkailing injection. Medicine Herald, 2000, 19(3): 139.
1 1 Yang Guancheng. Three cases of mental symptoms caused by Qingkailing. China Hospital Pharmacy Journal, 1997,17 (11): 521.
12 Wang Lianfen, Zhao. Contraindications of compatibility between Qingkailing injection and commonly used liquid drugs. Modern nursing, 200 1, 7 (1): 4 1.
13 Li Chunsheng, Wang,. Clinical efficacy, therapeutic relationship and adverse reactions of Qingkailing injection in the treatment of acute upper respiratory tract infection. China Journal of Traditional Chinese Medicine, 2002,25 (7): 432.
Stone 14. Serious side effects of Qingkailing injection and its nursing care. Shizhen traditional Chinese medicine, 200 1, 12 (6): 1 1.
Authors: Cardiovascular Department of Guangzhou Military Region 105 10, Guangzhou.