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对于有食物过敏引发过敏反应风险的儿童和青少年，肾上腺素自动注射器的针头长度是否不合适？

Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?

作者信息

Dreborg Sten, Wen Xia, Kim Laura, Tsai Gina, Nevis Immaculate, Potts Ryan, Chiu Jack, Dominic Arunmozhi, Kim Harold

机构信息

Women's and Children's Health, University of Uppsala, Uppsala, Sweden.

Faculty of Science, McGill University, Montreal, Canada.

出版信息

Allergy Asthma Clin Immunol. 2016 Mar 6;12:11. doi: 10.1186/s13223-016-0110-8. eCollection 2016.

DOI:10.1186/s13223-016-0110-8
PMID:26949403
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4779571/
Abstract

BACKGROUND

Food allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis. We examined if children and adolescents at risk of anaphylaxis weighing 15-30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available EAI in North America and Europe.

METHODS

The distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure (max) or slight pressure (min) in 102 children weighing 15-30 kg (group 1) and 100 children and adolescents, weighing more than 30 kg (group 2).

RESULTS

Using a high pressure EAI (HPEAI), Epipen Jr(®) and Auvi-Q(®)/Allerject(®) 0.15 mg, 11/102 (11 %) children in group 1 and 38/102 (38 %) using another HPEAI, Jext(®), had a STMDmax that showed a risk of intraosseous injection. There was a 1 % risk of subcutaneous injection with these devices. There was no risk of intraosseous injection using a low pressure EAI (LPEAI), Emerade(®). In group 2, the risk of intraosseous injection using a HPEAI was 3 % and no risk using a LPEAI. However, the risk of subcutaneous injection using HPEAI was 9 % and using LPEAI was 2 %.

CONCLUSION

There is a risk of intraosseous injection using HPEAI (Epipen(®)/Epipen Jr(®), Auvi-Q(®)/Allerject(®) and especially Jext(®)) in children at risk of anaphylaxis. There was also a risk of subcutaneous injection using the currently available HPEAI in children and adolescents.

摘要

背景

食物过敏是儿童过敏反应最常见的原因。肌内注射肾上腺素自动注射器（EAI）是治疗过敏反应的标准护理方法。我们研究了北美和欧洲目前可用的EAI对体重15 - 30千克和>30千克的有过敏反应风险的儿童和青少年进行肌内注射肾上腺素时，是否能将药物注射到肌内空间。

方法

通过超声在102名体重15 - 30千克的儿童（第1组）和100名体重超过30千克的儿童及青少年（第2组）的右大腿前外侧中三分之一区域测量皮肤到肌肉（STMD）和皮肤到骨骼（STBD）的距离，测量时分别施加高压（最大值）或轻微压力（最小值）。

结果

使用高压EAI（HPEAI），即Epipen Jr(®)和Auvi - Q(®)/Allerject(®) 0.15毫克时，第1组中11/102（11%）的儿童和使用另一种HPEAI即Jext(®)的102名儿童中的38/102（38%），其最大STMD显示有骨内注射风险。使用这些设备有1%的皮下注射风险。使用低压EAI（LPEAI）Emerade(®)没有骨内注射风险。在第2组中，使用HPEAI的骨内注射风险为3%，使用LPEAI没有风险。然而，使用HPEAI的皮下注射风险为9%，使用LPEAI为2%。

结论

有过敏反应风险的儿童使用HPEAI（Epipen(®)/Epipen Jr(®)、Auvi - Q(®)/Allerject(®)，尤其是Jext(®)）存在骨内注射风险。目前可用的HPEAI在儿童和青少年中也存在皮下注射风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85ce/4779571/5fe6ad2e355c/13223_2016_110_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85ce/4779571/09ae3376fbef/13223_2016_110_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85ce/4779571/95f732ec6607/13223_2016_110_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85ce/4779571/5fe6ad2e355c/13223_2016_110_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85ce/4779571/09ae3376fbef/13223_2016_110_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85ce/4779571/95f732ec6607/13223_2016_110_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/85ce/4779571/5fe6ad2e355c/13223_2016_110_Fig3_HTML.jpg

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Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine.肾上腺素在过敏反应中的应用：与肌内注射肾上腺素相比，静脉推注肾上腺素后发生心血管并发症和用药过量的风险更高。
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Epinephrine auto-injectors: is needle length adequate for delivery of epinephrine intramuscularly?肾上腺素自动注射器：针的长度是否足以进行肾上腺素的肌肉注射？
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