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我们近遇1例肌注狂犬疫苗引起的严重不良反应病人现报告如下。患者女,27岁。于1990年1月9日上午被犬咬伤,随即在当地肌注狂犬疫苗2ml(产地、批号不详)。注射后约半小时即出现心前区不适,胸闷,呼吸困难。于上午9点50分急转院诊疗,患者平素健康。查休:患者神志清,急性病容,血压12/9.3kPa,呼吸24次,心率102次分,律不齐,心尖区第一心音低纯,各瓣膜区未闻病理性杂音。双肺听诊正常。心电图:加速性界性逸搏心律;急性房室分离;不完全右束支传导阻滞;低电压;心肌损伤。化验:WBC 8×10~9/L,尿常规(～)。患者入院即给10%葡萄糖注射液500ml,维生素C 2g,三磷酸腺苷40mg,辅酶A100u,氟美松10mg,肌苷0.2g 静点。竖日凌晨一时,突感头晕,胸闷,憋喘加剧,且有恶心,呕吐。血压9.3/6.7kPa,心率60次。心电图:Ⅲ°房室传导阻滞。化验:WBC10×10~9/L。尿常规:蛋白(+),白细胞(++),红细胞(+++),管型少许。
We are close to one case of intramuscular rabies vaccine caused serious adverse reactions are reported as follows. Female patient, 27 years old. In the morning of January 9, 1990 was bitten by dogs, rabbits immediately in the local muscle vaccine 2ml (origin, lot number unknown). About half an hour after injection, there is precordial discomfort, chest tightness, and difficulty breathing. At 9:50 AM emergency hospital, the patient usually healthy. Check off: patients with clear consciousness, acute illness, blood pressure 12 / 9.3kPa, breathing 24 times, heart rate 102 times, irregular, apical first heart sound low purity, the valve area is not heard pathological murmur. Double lung auscultation normal. Electrocardiogram: Accelerative borderline escape rhythm; acute atrioventricular separation; incomplete right bundle branch block; low voltage; myocardial injury. Laboratory: WBC 8 × 10 ~ 9 / L, urine (~). Patients admitted to give 10% glucose injection 500ml, vitamin C 2g, adenosine triphosphate 40mg, coenzyme A100u, dexamethasone 10mg, inosine 0.2g static point. As early as 1am, the sudden sensation of dizziness, chest tightness and wheezing aggravated, and nausea and vomiting. Blood pressure 9.3 / 6.7kPa, heart rate 60 times. ECG: Ⅲ ° atrioventricular block. Laboratory: WBC10 × 10 ~ 9 / L. Urine: protein (+), white blood cells (++), red blood cells (+++), a little tube.