2例患者置管后均出现血压骤降、过敏性休克表现,医护及时发现并果断采取措施积极抢救是成功关键所在。这与静脉通路中心人员隶属于ICU,平时熟练掌握过敏性休克流程密不可分。在患者出现休克症状后,能及时判断可能的过敏源并去除,开放静脉输液通道、扩容抗休克、并予患者氧气吸入、肾上腺素、糖皮质激素等减轻致敏反应,密切监护患者生命体征,最终患者转危为安。综合这2例患者的救治过程,应注意护理工作不能疏忽,置管前护士应辅助详细询问患者药物过敏史,留意高过敏体质患者,及时告知医师该类患者,慎用抗感染中心静脉导管,并做好过敏的相关预防工作;穿刺过程中一旦高度怀疑导管抗生素涂层过敏,应首先消除过敏源及时拔除导管;对于置管后出现过敏反应,应沉着冷静协助医生积极干预,正确执行医嘱;熟悉过敏性休克的抢救流程,熟练掌握各项急救操作,医护密切配合,加强患者心理疏导,缓解其紧张情绪。
氯己定涂层的采用,使抗感染中心静脉导管较普通中心静脉导管在血管内留置时间延长,降低了医院导管相关性感染的发生率。结合2年来我院ICU 8000例左右置管病历数据,临床考虑氯己定所致过敏性休克患者仅此2例,其发生属罕见,但仍需时刻警惕该类药物所致的严重过敏反应并积极救治。
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