Carney-Gersten P, Giuffre M, Levy D
University of Washington School of Nursing, Seattle.
Oncol Nurs Forum. 1991 May-Jun;18(4):745-50.
Amphotericin-B is the only parenteral agent currently available to treat systemic fungal infections. Pyrogenesis, accompanied by severe shivering, is a distressing side effect. Possible risk factors of developing this reaction have not been reported. A case series was developed to document the occurrence and duration of shivering in patients who received amphotericin-B and to investigate whether these responses were associated with a diagnosis of diabetes mellitus, receipt of insulin or beta blockers, the amount of body fat content, an immunocompromised state, age, and gender. Medical records were reviewed and abstracted for patients who received 20 milligrams or more of amphotericin-B per day for at least 10 consecutive days between January 1, 1984, and September 1, 1988. Results indicated that a diagnosis of diabetes, insulin therapy, and advancing age were inversely associated with the amphotericin-B-induced rigors response. Shivering was noted to occur first at the test dose, with the percentage of patients who shivered increasing with each successive dose (this peaked at the fifth therapeutic dosage). Of the factors under study, only advancing age appeared to be related to the duration of shivering. It is possible that identification of the descriptive characteristics of amphotericin-B-induced rigors will facilitate the nursing care of patients who receive this treatment; it also may be an important first step in the identification of risk factors for this clinical complication.
两性霉素B是目前唯一可用于治疗全身性真菌感染的肠胃外用药。发热并伴有严重寒战是一种令人痛苦的副作用。尚未有关于发生这种反应的可能风险因素的报道。开展了一个病例系列研究，以记录接受两性霉素B治疗的患者寒战的发生情况和持续时间，并调查这些反应是否与糖尿病诊断、胰岛素或β受体阻滞剂的使用、体脂含量、免疫功能低下状态、年龄和性别有关。对1984年1月1日至1988年9月1日期间连续至少10天每天接受20毫克或更多两性霉素B治疗的患者的病历进行了回顾和摘要分析。结果表明，糖尿病诊断、胰岛素治疗和年龄增长与两性霉素B引起的寒战反应呈负相关。寒战首先在试验剂量时出现，寒战患者的百分比随着每次后续剂量的增加而增加（在第五次治疗剂量时达到峰值）。在所研究的因素中，只有年龄增长似乎与寒战持续时间有关。确定两性霉素B引起的寒战的描述性特征可能有助于对接受该治疗的患者进行护理；这也可能是识别这种临床并发症风险因素的重要第一步。
