论文部分内容阅读
目的:探讨新生儿抗菌药物过敏反应的发生情况和临床特征。方法:收集2015年1月1日至2017年12月31日成都市妇女儿童中心医院新生儿科抗菌药物过敏反应报表，根据报表提供的患儿基本信息，检索医院信息系统收集患儿的电子病历，记录抗菌药物应用和过敏反应发生、治疗、转归情况，由3位药师根据相关标准对药物过敏反应的临床表现、分型和严重程度进行统一判定。通过医院信息系统统计同期新生儿科就诊和住院患儿总例数并记录其抗菌药物使用情况，计算抗菌药物过敏反应发生率。结果:设定时段新生儿科抗菌药物过敏反应报表共73份，涉及73例患儿；同期使用抗菌药物的患儿为21 146例，抗菌药物过敏反应发生率为0.35%。73例患儿中男性34例，女性39例；就诊或入院时的日龄为（14±7）d；使用注射制剂抗菌药物者69例（94.52%），口服制剂者4例（5.48%）。所用抗菌药物共7类20个品种，占比居前3位者为头孢菌素类（32例，43.84%）、青霉素类（21例，28.77%）和头霉素类（6例，8.22%）；过敏反应发生率居前3位者为盐酸左氧氟沙星注射液（2/4）、注射用乳糖酸红霉素[1.29%（4/311）]和注射用盐酸万古霉素[1.07%（4/374）]。73例患儿中过敏反应呈速发型者4例（5.48%），其中3例为严重病例（过敏性休克、呼吸困难、严重过敏样反应各1例）；非速发型69例（94.52%），主要表现为皮疹、消化系统症状和发热，其中6例为严重病例（肝胆系统损伤3例、粒细胞减少症2例、重症药疹1例）。经停药和/或抗过敏、对症治疗后，73例患儿中71例（97.26%）痊愈，2例（2.74%）好转。结论:成都市妇女儿童中心医院新生儿抗菌药物过敏反应率为0.35%。新生儿抗菌药物过敏反应的临床分型以非速发型为主，多为一般过敏反应，但速发型多为严重过敏反应。“,”Objective:To explore the occurrence and clinical characteristics of hypersensitivity reactions induced by antimicrobial drugs in neonates.Methods:The reports of hypersensitivity reactions induced by antimicrobial drugs in Neonatology Department of Chengdu Women′s and Children′s Central Hospital from January 1, 2015 to December 31, 2017 were collected. According to the basic information of children provided by the reports, the electronic medical records of the children were collected from the hospital information system and the data of application, occurrence, treatments, and outcomes of hypersensitivity reactions were recorded. The clinical manifestations, types, and severity of hypersensitivity reactions were evaluated by 3 pharmacists according to relevant standards. From the hospital information system, the total number of outpatients and inpatients in Department of Neonatology in the same period was counted, the usage of antimicrobial drugs was recorded, and the incidence of hypersensitivity reactions due to antimicrobial agents was caculated.Results:A total of 73 reports of hypersensitivity reactions to antimicrobial drugs in Department of Neonatology were entered, involving 73 newborn infants; there were 21 146 infants using anti-microbial agents at the same time, so the incidence of antimicrobial hypersensitivity reactions was 0.35%. Among the 73 children, 34 were male and 39 were female; the ages on visit or admission to the hospital was (14±7) days; 69 (94.52%) were given injections of antimicrobial agents and 4 (5.48%) were given oral preparations. A total of 20 antimicrobial agents of 7 categories were used; the top 3 were cephalosporins (32 infants, 43.84%), penicillins (21 infants, 28.77%), and cephamycins (6 infants s, 8.22%). The top 3 drugs with higher incidence of hypersensitivity reactions were levofloxacin hydrochloride injection (2/4), erythromycin lactobionate for injection [1.29% (4/311)], and vancomycin hydrochloride for injection [1.07% (4/374)]. Among the 73 infants, 4 (5.48%) had immediate hypersensitivity reactions, of which 3 were severe (including 1 with anaphylactic shock, 1 with dyspnea, and 1 with severe anaphylactic reaction) cases; 69 (94.52%) had nonimmediate hypersensitivity reactions, mainly manifested as rash, digestive system symptoms, and fever, of which 6 were severe cases (including 3 infants with hepatobiliary system injury, 2 with neutropenia, and 1 with severe drug eruption). After discontinuation of suspected drugs and/or antiallergic and symptomatic treatments, 71 of 73 newborns recovered (97.26%) and 2 (2.74%) improved.Conclusions:The incidence of hypersensitivity reactions induced by antimicrobial drugs in newborns in Chengdu Women′s and Children′s Central Hospital was 0.35%. The clinical types of hypersensitivity reactions induced by antimicrobial drugs in neonates were mainly nonimmediate types, most of them were general hypersensitivity reactions, but the immediate drug hypersensitivity reactions were mostly severe hypersensitivity reactions.