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患者女,51岁.因乏力、纳差7个月并逐渐加重,且伴腹水3个月,以肝硬化并腹水于19920918入院.入院后,经保肝、退黄、降酶、利水等支持疗法,自觉症状有所减轻.于9月27日出现发热,体温在37.8—38.6℃之间波动,下腹部有压痛和轻微反跳痛,考虑腹水感染.10月2日用氨苄西林静滴1周,体温正常,于10月13日停药.10月21日又出现体温波动,且均为午后低热.不超过38℃.体检:少量腹水,下腹部轻压痛和反跳痛.于10月23日用头孢噻肟钠(华北制药总厂生产,批号910908),皮试(一)后,投用 3.0g,加50%葡萄糖40mL,iv(静注),缓注约5min.输注30mL时,患者口诉不适,面部发热、潮红,立即停药.2min后,患者感到胸闷、呼吸困难、恶心呕吐.体检:面色苍白、烦躁、呼吸障碍,BP 6/4kPa,P104次/min,R26次/min,心律齐,ECG示窦性心动过速.考虑为过敏性休克,立即给氧、肾上腺素1mg、氟米松5mg、im;多巴胺40mg、间羟胺20mg静滴,半小时后病情好转,憋气、胸闷等症状消失,呼吸平稳.实验室检查:嗜酸粒细胞5%,IgE 1.0mg/L.
Female patient, aged 51. Because of fatigue, anorexia for 7 months and gradually increased, and with ascites for 3 months to cirrhosis and ascites in 19920918 admitted to the hospital, after liver, jaundice, Jiangni, diuresis and other support Therapy, symptoms subsided.Some fever occurred on September 27, body temperature fluctuations between 37.8-38.6 ℃, lower abdominal tenderness and slight rebound pain, consider ascites infection.October 2 with ampicillin intravenous infusion 1 Week, normal body temperature, withdrawal on October 13. October 21 and body temperature fluctuations occur, and are low in the afternoon heat does not exceed 38 ℃. Physical examination: a small amount of ascites, lower abdominal tenderness and rebound tenderness in October 23 days with cefotaxime sodium (North China Pharmaceutical Factory production, lot number 910908), skin test (a), cast with 3.0g, plus 50% glucose 40mL, iv (intravenous), slow injection of about 5min. Patients complained of discomfort, facial fever, flushing, immediate withdrawal .2min after the patient felt chest tightness, difficulty breathing, nausea and vomiting. Physical examination: pale, irritability, breathing disorders, BP 6 / 4kPa, P104 times / min, R26 Times / min, heart rate Qi, ECG showed sinus tachycardia .Absolutely considered for anaphylactic shock, epinephrine 1mg, flumetasone 5mg, im; dopamine 40mg, 20mg intravenous hydroxylamine intravenous infusion, Condition improved after half an hour, suffocating, chest tightness and other symptoms disappear, breathing stable. Laboratory tests: 5% eosinophils, IgE 1.0mg / L.