Analysis of successful and failed cases of allergic shock resuscitation
过敏性休克抢救成功与失败病例分析

摘要

目的 探究过敏性休克紧急救治过程中重要的临床判断对于最后的结果所产生的重大作用，深入研究抢救成功还是失败的干预界点，以期为改进急性重症救治路线提供证据支持。方法 回顾性总结分析近8年间在我院急诊科接受治疗的过敏性休克的62位病人详细的医疗干预档案；根据最后的客观疗效判定结果，将病例分成了抢救成功的组别和抢救失败的组别；采取查阅抢救时的护理记录单、心电监测记录，细致比较两组间在急救到达临界值的时间长短、首推主要药物给药途径、早期大量补液是否达标、高级气管保护干预前瞻性等多个重要方面是否存在明显的区别。结果 抢救成功组从症状出现到大腿前外侧肌肉注射肾上腺素的平均时间以及发病早期半小时内即刻输注晶体溶液合格表现、对进行性喉头水肿采取预防性气管内插管措施都具有压倒性的明显数值优势；抢救失败组则普遍存在着早期诊断失误或者致命的选择性用药失误等问题，在预测微循环灾难性崩溃的能力上严重不足。结论 过敏性休克急救的生与死在于及时的准确无误的临床上下及肾上腺素的应用，冲破急诊科医师的潜在认识误区，构建基于病理生理基础的标准化、执行力高的急救干预体系是整体扭转局面、减少死亡率的关键准则。

Abstract

Objective To explore the significant role of important clinical judgments during the emergency treatment of allergic shock in determining the final outcome, and to deeply study the intervention boundaries for success or failure of resuscitation, in order to provide evidence support for improving the acute critical care treatment route.
Methods A retrospective summary and analysis was conducted on the detailed medical intervention records of 62 patients with allergic shock who received treatment in the emergency department of our hospital over the past 8 years; based on the final objective therapeutic effect judgment results, the cases were divided into the successful resuscitation group and the failed resuscitation group; by reviewing the nursing records during resuscitation and electrocardiogram monitoring records, and carefully comparing multiple important aspects such as the duration of reaching the critical value of emergency arrival, the first recommended main drug administration route, the achievement of early large-volume fluid infusion standards, and the prospective advanced tracheal protection intervention, there were obvious differences between the two groups.
Results The average time from symptom onset to thigh anterior lateral muscle injection of epinephrine in the successful resuscitation group, the qualified performance of immediate infusion of crystalloid solutions within half an hour of onset, and the preventive intubation measures for progressive laryngeal edema all had overwhelming obvious numerical advantages; the failed resuscitation group generally had problems such as early diagnosis errors or fatal selective medication errors, and was seriously deficient in the ability to predict catastrophic microcirculation collapse.
Conclusion   The survival or death of allergic shock emergency resuscitation lies in timely and accurate clinical decisions and the application of epinephrine, breaking through the potential misunderstandings of emergency department physicians, and constructing a standardized and highly executable emergency intervention system based on pathophysiological basis is the key criterion for overall turning the situation and reducing mortality.