在儿科患者中对阿纳菲拉克西斯给予上腺素后,评估观察期的实践模式
Hannah B Short1, Benjamin Walters1, Maria Fabi1
1Department of Emergency Medicine, Penn State College of Medicine, Hershey, USA.
Cureus
|October 15, 2024
概括
目前的指导方针建议对过敏反应患者进行4-6小时的观察. 这项研究发现,双相反应发生在这个时期内和之后,这表明对儿科过敏症管理的个性化观察.
科学领域:
- 儿科急救医学 儿科急救医学
- 过敏和免疫学 过敏和免疫学
- 临床研究 临床研究
背景情况:
- 目前的过敏反应指南建议在上腺素后观察4-6小时,以监测两相反应.
- 关于这些指南的有效性存在相互矛盾的数据,特别是在儿科患者群体中.
- 双相反应是过敏反应症状的复发,而不会再次暴露于触发因素.
研究的目的:
- 评估当前对儿科患者过敏反应观察指南的适当性.
- 分析上腺素管理后双相反应发展的时间和模式.
- 为了确定儿童双相反应的潜在风险因素.
主要方法:
- 在第三级学术医疗中心ED (2017-2022) 对292名儿科患者 (18岁以下) 进行了回顾性研究,这些患者因过敏反应而接受了上腺素治疗.
- 观察时间的分析,上腺素的时间,症状特征,过敏原类型和两相反应的发生.
- 使用应急表和t测试,比较发生和没有发生双相反应的患者之间的变量.
主要成果:
- 3.4% (10/292) 的儿科患者出现了两相反应.
- 症状消失后150分钟内和症状消失后10小时内 (出院后) 都发生了反应.
- 两组之间没有发现ED观察时间或第一剂上腺素剂量的时间有显著差异. 呼吸系统症状与上腺素后持续症状有关.
结论:
- 儿科过敏反应中的双相反应可能发生在标准的4-6小时观察窗口之外.
- 延长观察期可能不会防止所有放电后的双相反应.
- 对过敏反应观察的个性化方法,考虑诸如呼吸道干扰等因素,可能更合适,可能减少低风险患者的ED负担.
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