Fisher M M, Baldo B A
Intensive Therapy Unit, Royal North Shore Hospital of Sydney, St Leonards, NSW.
Med J Aust. 1988 Jul 4;149(1):34-8. doi: 10.5694/j.1326-5377.1988.tb120481.x.
Anaphylactic shock may be provoked by a diverse group of substances and stimuli, which range from large molecular weight proteins and small drug molecules to some colloids, emulsions and even exercise. The underlying mechanism may be immunological or non-immunological but, regardless of the mechanism, the physiological effects and the observable symptoms of anaphylaxis are due to the release of potent pharmacologically-active mediators, including histamine. Although a number of predisposing factors are recognized, the appearance of most of the reactions cannot be predicted. Reactions occur suddenly and dramatically and progress rapidly. Cardiovascular collapse is the most common life-threatening clinical feature, while bronchospasm is the most difficult to treat. The primary aim of treatment should be to treat the underlying cause and to improve cellular oxygenation. The pharmacological agent of choice for treatment is adrenaline. It is direct-acting and is effective for both bronchospasm and cardiovascular collapse. It is imperative that the provoking substance or stimulus be identified in patients and there is no substitute for a carefully-gathered and detailed case history in the diagnosis of anaphylaxis. Patients should be issued with some form of warning identification together with written details concerning their reaction.
过敏性休克可能由多种物质和刺激因素引发，从大分子蛋白质、小分子药物到某些胶体、乳剂甚至运动。其潜在机制可能是免疫性的或非免疫性的，但无论机制如何，过敏反应的生理效应和可观察到的症状都是由于强效药理活性介质（包括组胺）的释放所致。尽管已认识到一些诱发因素，但大多数反应的出现无法预测。反应突然且剧烈，并迅速进展。心血管衰竭是最常见的危及生命的临床特征，而支气管痉挛是最难治疗的。治疗的主要目标应是治疗潜在病因并改善细胞氧合。治疗的首选药物是肾上腺素。它具有直接作用，对支气管痉挛和心血管衰竭均有效。必须在患者中识别出诱发物质或刺激因素，在过敏性反应的诊断中，仔细收集和详细的病史是无可替代的。应向患者发放某种形式的警示标识以及有关其反应的书面详细信息。
