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目的了解接种疫苗所致过敏性休克发生的特点和规律,为规范处理和科学鉴定接种疫苗所致过敏性休克提供依据。方法采用系统评价的方法,检索万方数据库和中国医院知识仓库总库(2000～2010年),对获得的文献进行质量评价,从合格文献中提取相关信息进行分析。结果共纳入52篇文献的76例个案,其中男性56例,女性20例,男女性比例为2.8:1。发病年龄最大69岁,最小仅出生1d,各年龄组均有发生。共涉及17种疫苗,54例为接种灭活疫苗,20例为接种减毒活疫苗,2例为同时接种减毒活疫苗和灭活疫苗。其中居前三位的是人用狂犬病疫苗(14例)、乙型肝炎疫苗(13例)、流行性乙型脑炎灭活疫苗(8例)。接种疫苗至发生过敏性休克的时间最短1min,最长4h,中位数时间为10min。最终结局有9例死亡,67例痊愈。临床表现以呼吸急促、呼吸困难、血压下降、紫绀、四肢湿冷、面色苍白、意识不清或丧失为主要症状和体征。结论报道的文献中,87.3%的接种疫苗所致过敏性休克发生于接种后30min内,接种后应至少留观30min,接种后4h内仍要注意受种者身体情况。接种医生应掌握过敏性休克现场急救知识和技能,应重点关注呼吸急促、呼吸困难、血压下降、紫绀、四肢湿冷、面色苍白、意识不清或丧失等症状和体征。
Objective To understand the characteristics and rules of the onset of anaphylactic shock caused by vaccination and provide basis for standardizing the handling and scientific identification of anaphylactic shock caused by vaccination. Methods A systematic review method was used to search the database of Wanfang Database and China Hospital Knowledge Base (from 2000 to 2010). The quality of the obtained documents was evaluated. Relevant information was extracted from qualified documents for analysis. Results A total of 76 cases were included in 52 articles, including 56 males and 20 females. The ratio of male to female was 2.8: 1. The oldest age of 69 years, the youngest only 1d, all age groups have occurred. A total of 17 vaccines were involved, 54 vaccinated inactivated vaccines, 20 vaccinated live attenuated vaccines, and 2 vaccinated live attenuated and inactivated vaccines. The top three were rabies vaccine for human (14 cases), hepatitis B vaccine (13 cases) and Japanese encephalitis inactivated vaccine (8 cases). Vaccination to the occurrence of anaphylactic shock the shortest 1min, up to 4h, the median time was 10min. Nine patients were ultimately fatal and 67 were cured. Clinical manifestations of shortness of breath, difficulty breathing, blood pressure, cyanosis, cold limbs, pale, unconsciousness or loss as the main symptoms and signs. Conclusion In the reported literature, 87.3% of vaccinated-induced anaphylactic shock occurred within 30 minutes after inoculation. At least 30 minutes after inoculation should be observed. After vaccination, attention should be paid to the recipient’s body condition within 4 hours after inoculation. Inoculation doctors should master the first-aid knowledge and skills of the scene of anaphylactic shock, and should pay attention to shortness of breath, difficulty breathing, blood pressure drop, cyanosis, cold and limbs, pale, unconsciousness or loss and other symptoms and signs.