关节腔内注射双氯芬酸乙磺酸钠致过敏性休克：一例报告
Anaphylactic shock due to intra-articular injection of diclofenac etalhyaluronate sodium: A case report.
作者信息
Yatabe Tomoaki, Mizutani Akihito, Ito Takashi, Ono Ricart Yukika, Watanabe Maasa, Uchiyama Sohta
机构信息
Emergency Department Nishichita General Hospital Tokai Japan.
Department of Anesthesiology and Intensive Care Medicine Nishichita General Hospital Tokai Japan.
出版信息
Acute Med Surg. 2023 Oct 6;10(1):e898. doi: 10.1002/ams2.898. eCollection 2023 Jan-Dec.
BACKGROUND
Anaphylactic shock of diclofenac etalhyaluronate agent can be prolonged and recurrent. However, its reports are rare, and consequently, its method of management remains to be established.
CASE PRESENTATION
A 65-year-old woman received an intra-articular injection of diclofenac and hyaluronate. After 20 min, systemic urticaria and severe hypotension developed after walking. After an intramuscular adrenaline injection, she was transferred to our hospital. Despite administration of continuous noradrenaline and adrenaline, hypotension persisted. Seven hours after the joint injection, 25 mL of knee joint fluid was aspirated under ultrasound guidance. Mobilization was performed 24 h after joint injection. However, urticaria rapidly spread after standing. At 45 and 46 h after joint injection, we confirmed that no symptoms, including urticaria, recurred after walking.
CONCLUSION
Anaphylactic shock due to intra-articular injection of diclofenac etalhyaluronate is prolonged and requires extended observation. Aspiration of joint fluid may be one of the treatment options.
背景
双氯芬酸乙磺酸盐制剂引起的过敏性休克可能持续时间长且反复发作。然而，相关报道罕见，因此其治疗方法仍有待确定。
病例报告
一名65岁女性接受了双氯芬酸和透明质酸盐的关节腔内注射。20分钟后，行走后出现全身性荨麻疹和严重低血压。肌肉注射肾上腺素后，她被转送至我院。尽管持续给予去甲肾上腺素和肾上腺素，低血压仍持续存在。关节注射7小时后，在超声引导下抽取了25毫升膝关节液。关节注射24小时后进行了活动。然而，站立后荨麻疹迅速蔓延。关节注射后45和46小时，我们确认行走后未再出现包括荨麻疹在内的症状。
结论
关节腔内注射双氯芬酸乙磺酸盐引起的过敏性休克持续时间长，需要延长观察时间。抽取关节液可能是治疗选择之一。
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