Posner Larry S, Camargo Carlos A
North Bay Allergy and Asthma Associates, Inc., Napa, CA.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Drug Healthc Patient Saf. 2017 Mar 21;9:9-18. doi: 10.2147/DHPS.S121733. eCollection 2017.
Anaphylaxis is a serious, potentially fatal allergic reaction. Guidelines recommend prompt intramuscular injections of epinephrine as the first-line therapy for anaphylaxis. Delayed epinephrine treatment may cause undesirable clinical outcomes, including death. In the community, epinephrine auto-injectors (EAIs) are commonly used to treat anaphylaxis. This literature review examines several recent concerns regarding the safety of EAIs that may prevent the timely administration of epinephrine. Reports of cardiovascular complications are linked with epinephrine administration, although recent studies suggest that these events are much more commonly associated with intravenous epinephrine rather than with EAIs. Recent studies have also highlighted accidental injections of EAIs in patients' or caregivers' fingers and lacerations associated with the use of EAI in children. However, the data suggest that both accidental injections and lacerations are rare and require limited medical intervention. In addition, patients may receive conflicting information on the safety and efficacy of using expired EAIs. Overall, it is believed that the benefits of using EAIs far outweigh the potential risks of not administering an EAI. Although legitimate safety concerns are associated with EAIs, adverse events are rare. Continued training of medical providers, caregivers, and patients may be beneficial to address these concerns and reduce EAI-associated injuries while ensuring that patients receive necessary medical care.
过敏反应是一种严重的、可能致命的过敏反应。指南推荐立即肌内注射肾上腺素作为过敏反应的一线治疗方法。延迟使用肾上腺素治疗可能会导致不良临床后果，包括死亡。在社区中，肾上腺素自动注射器（EAIs）常用于治疗过敏反应。这篇文献综述探讨了近期有关EAIs安全性的几个问题，这些问题可能会妨碍及时给予肾上腺素治疗。心血管并发症的报告与肾上腺素给药有关，尽管近期研究表明这些事件更常与静脉注射肾上腺素相关，而非与EAIs相关。近期研究还强调了EAIs意外注射到患者或护理人员手指的情况，以及在儿童中使用EAIs相关的撕裂伤。然而，数据表明意外注射和撕裂伤都很罕见，且只需有限的医疗干预。此外，患者可能会收到关于使用过期EAIs的安全性和有效性的相互矛盾的信息。总体而言，人们认为使用EAIs的益处远大于不使用EAIs的潜在风险。虽然EAIs存在合理的安全问题，但不良事件很少见。持续对医疗服务提供者、护理人员和患者进行培训，可能有助于解决这些问题，减少与EAIs相关的伤害，同时确保患者获得必要的医疗护理。
