重复上腺素的时间以告知儿科过敏反应的观察期:一个回顾性队列研究
Timothy E Dribin1, Hugh A Sampson2, Yin Zhang3
1Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
The Lancet. Child & adolescent health
|June 12, 2025
概括
大多数在急诊室接受过敏反应治疗的儿童在观察2小时后可以安全出院. 对于心血管疾病患者来说,4小时可能足够,减少不必要的住院时间.
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
- 临床药理学 临床药理学
背景情况:
- 在儿童中,过敏反应的管理往往涉及长时间的观察期后上腺素的管理.
- 复发或持续的症状需要延长急诊室停留时间或住院.
- 确定最佳观察持续时间对于安全有效的患者出院至关重要.
研究的目的:
- 计算儿科过敏反应中重复使用上腺素的发病率和时间.
- 建立一个基于证据的观察值,以确保在治疗上腺素后安全出院.
- 确定放电的最佳时间,以最大限度地降低两相反应的风险.
主要方法:
- 在美国和加拿大的31个急诊室对接受上腺素治疗的儿童 (6个月17岁) 进行了回顾性队列研究.
- 分析电子医疗记录的人口统计,反应严重程度,并在出院后72小时内重复注射上腺素.
- 卡普兰-梅尔分析以确定最后一剂上腺素的时间,按呼吸和心血管参与分层.
主要成果:
- 在5641名符合条件的儿童中,4.7%的儿童在2小时后接受重复上腺素,1.9%在4小时后,0.8%在8小时后.
- 所有患者的累计重复上腺素发病率低于2%的观察期为115分钟.
- 患有心血管疾病的患者需要较长的观察期 (161分钟) 与没有 (105分钟) 的患者相比.
结论:
- 对于大多数为过敏反应而接受上腺素治疗的儿童来说,两小时的观察期似乎是安全的.
- 4小时的观察可能足以看起来良好的儿科患者心血管参与.
- 这些发现支持对儿科过敏反应的当前出院协议进行修订.
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