1 case of anaphylactic shock caused by injection with asharp-kissed python blood clotting enzyme

Anaphylactic shock is a serious, life-threatening systemic rapid-onsergic reaction, which is the most serious of adverse drug reactionsIts definition is that some antigen substances from the outside world enter the emylate body, through theimmunemechanism in a short period of time occurred in a strong multi-dirty device tired groupAnaphylactic shock can be found in all departments of the hospital and can occur in patients who have used or come into contact with the drugThe cause of death is mainly acute respiratory obstruction, followed by circulatory failure, anaphylactic shock that can rapidly develop from the initial mild skin symptoms to death within minutesDue to the rapid development and intensity of the disease, the resulting death can occur within minutes, must be quickly and promptly rescue measures1Case introductionpatients, female, 50 years old, body mass 55kg, no drugs, food allergy historyThe patient is healthy and has no abnormality in the whole body examination before admission to hospitaldiagnosedas dysfunctional uterine haemorrhage, on June 19, 2017, it was proposed tolaparoscopyunder the whole uterus plus two-sided fallopian tube excisionPatients were given 40min before surgery as directed by the doctor to preventive application antibiotic : sterilization injection water 20 ml , sodium cephalosporin (skin test) 1.5g intravenous injection, no adverse reactions were found the normal routine monitoring of vital signs: blood pressure 110/60mmHg, heart rate 80 times/min, blood oxygen saturation 98%, general induced double-cavity larynx general anesthesia Anesthesia smoothly and smoothly, the vital signs are stable Surgery first to give the gas abdominal needle puncture test water success after the coin abdominal flow began 3L /min, reached the set pressure of 12mmHg after the replacement of 10mm puncturer, to determine the carbon dioxide gas abdominal flow adjusted to 20L/min after the abdominal cavity Carbon dioxide abdominal normal, surgical field exposure clear Surgery began about 13min after the operation due to the surgical surface blood-permeable bipolar electrocoagulation is not easy to stop the bleeding, according to the doctor's instructions to give injection with a sharp kiss python blood clotting enzyme (commodity name: Su Ling, Beijing Kangchen Pharmaceutical Co., Ltd., the National Drug Code: H20080633, specifications: 1U / bottle) 2U-infusion injection water 2ml infusion infusion of potassium-to-oxygen glucose injection ( at this time intravenous injection of potassium-to-oxygen glucose injection) about 10min after the blood pressure suddenly dropped to 42/28mm-Hg, heart rate 100 times /min, blood oxygen saturation of 96% Subsequently, the lowest blood pressure to 32/21mmHg, heart rate rose to 155 times / min, blood oxygen saturation 94%, airway pressure rose to 30 to 35mmHg, check the larynx cover and full hemp ventilator and other pipes no abnormalities, blood pressure cuffs and blood oxygen probes, such as normal, surgery wild bleeding is not much consider anaphylactic shock, immediately follow the doctor's instructions to dexamethasone 20 mg intravenous injection, hydrochloric acid epinephrine 0.1 mg intravenous injection 2 times, ephedrine 12 mg intravenous injection, hydrochloric acid epinephrine 1 mg plus 5% sodium chloride 250 mg intravenous drip, 10% glucose calcium 1 g dilution intravenous injection, psiemian 20 mg intravenous injection, anti-hypothermia, anti-shock, anti-shock, etc The whole hemp ventilator continuously positivepressure to oxygen blood pressure rose to 60/40mmHg, heart rate 140 times/min after 10min, blood pressure was 95/55mmHg, heart rate 135/min after 20min, blood pressure after 25min was 110/65mmHg, heart rate 110/min, airway pressure was normal, blood oxygen saturation 98%, and then the life was sustained, with a total of 950ml urine simultaneously observed face and eye conjunctiva gradually edema, right palm and forearm (peripheral venous pathways in the right back) gradually swollen and stiff, left hand and other limb parts of the skin did not find swelling and stiffness After the above treatment, the symptoms gradually alleviate or even disappear The operation continued, the course went smoothly, after the operation pulled out the larynx to send the anaesthetic recovery room to continue observation The vital signs were stable during the anaesthetic recovery and after returning to the ward, and no adverse reactions were found during postoperative follow-up until discharge from the hospital The patient was in a full-throat mallet state during the operation, and the laryngeal tube kept the airways open to win time for rescue preparation Close observation and continuous monitoring of vital signs during surgery, so the first time to find abnormal vital signs and take timely and effective rescue measures, so that patients turn to safety 2 Discussion of patients with anaphylactic shock in surgery consider three possible conditions: (1) preoperative use of antibiotics sodium cephalosporine; The antibiotic cephalosporins can basically be excluded for the following reasons: the preoperative 3d patients to do uterine surgery before the routine to give the antibiotic, as well as after this operation and then use a group of the drug (all the same batch number) did not find adverse reactions Whole drug, with anesthesiologist to discuss all-drug allergy can basically be eliminated Subcutaneous emphysema and shock caused by co-operative co-operative celiacs can also be excluded, as follows: carbon dioxide gas into the abdominal cavity exactly, did not form subcutaneous emphysema; anaphylactic shock is characterized by high risk, generally lightning-like occurrence, 5% of patients within 5 min after administration of symptoms 35% of the fluid in the vascular can rapidly penetrate into the blood vessels tissues within 10min, causing skin edema, throat edema, pulmonary edema, bronchospasm Injection with a sharp kiss python blood clotting enzyme, after a few minutes after giving the drug ananyllate shock reaction, from the patient after the drug life signs changes, face gradually edema, infusion side palms and forearms gradually swollen and stiff, elevated airway pressure and other manifestations can basically judge this case patient's allergic reaction and the use of injection with the injection of the injection of the sharp python blood clotting drug time has a clear causal relationship injection with the sharp kiss python blood clotting enzyme commodity named Su Ling, the main component of this product from the sharp kiss python snake venom to separate purified blood clottase, is the only product selling in China to complete all amino acid sequencing of a single component of the snake venomic coagulase drug, pharmacological action: through hydrolytic fibroprotein to make it into fibroprotein and enhance the body's blood clotting function to become a blood-stopping drug The characteristics are white freeze-dried lumps, specifications: 1U per bottle, use method for a single intravenous injection, 2U (2 bottles) each, each bottle with 1 ml of water to dissolve, slow intravenous injection assisted in the bleeding of the shallow surface of surgery Good effect and high safety, can reduce the amount of postoperative wound bleeding and postoperative drainage, shorten the time of hemorrhage It has been reported that the sharp-kissed python blood clotting enzyme can reduce the amount of bleeding and postoperative drainage during abdominal surgery, and is reliable and safe for the application of abdominal surgery After the drug is listed
clinical effect is accurate, the incidence of adverse reactions is low, is widely used in clinical , injection with the sharp kiss python blood clotting enzyme my hospital is also routinely used in gynaecological surgery At present, gynaecological surgery often encounter edifying, such as surgical peeling surface close to the bladder, ureter and intestinal tube, etc , electric clotting blood if there is electrical damage will lead to serious consequences Therefore, it is very important to choose a safe and effective method of hemostatic in gynaecological surgery Occasional allergic reactions, check the domestic literature has many reports that they have an allergic reaction or even severe anaphylactic shock Although the drug is widely used in clinical and rare adverse reactions, but after all, there is an allergic reaction or even a serious anaphylactic shock, before the use of the drug sensitivity test (skin test) In the application of the drug must first ask the patient whether the allergy history, the routine equipped with anti-allergy, anti-shock drugs and rescue equipment, the administration of the drug strictly in accordance with the instructions, strictly prohibitthetly with the drug is banned from the same line of the same line of administration, prohibited for the use of allergy patients in the drug, after the drug, especially after the drug within 10min must closely observe the changes in the disease; In the process of rescue, the serious implementation of medical instructions if necessary oral restatement 1 time, strict implementation of the system of inspection, so that rescue is correct In the rescue attention to keep warm, record the amount of urine, strict implementation of the principles of sterile technology operation An allergy is indicated on the patient's medical record that the drug is allergic and the patient is stressed that the next time the drug is not used Nurses master the characteristics of anaphylactic shock reaction and skilled first aid technology, timely detection of crisis situation and calm, calm, rapid, cooperate with the physician to rescue