Myocardial Depression in Anaphylaxis: Report of a Case and Review of the Literature

過敏反應導致心肌抑制：一病例報告

王先灝(Shane-Haw Wang) ； 劉明煇(Ming-Fei Liu)

《中華民國急救加護醫學會雜誌》 10卷2期 (1999/06) Pp. 76-82

https://doi.org/10.30018/JECCM.199906.0006

摘要

過去曾有過敏反應導致心肌操作的臨床報告，這些病例多數呈現爲心律不整或心肌缺血性變化，過敏反應直接造成心肌抑制的情況則絕少爲人提出。我們報告一位原來健康狀況良好的十五歲女孩，在蟲咬後短時間內出現急性肺水腫及低血壓，血清IgE昇高，心臓超音波顯示左心室射血分率極度降低（僅20%）。經投予抗組織胺、類固醇、利尿劑及多巴胺治療，短期內即完全復原，追縱心臓超音波也顯示心臓功能恢復正常。我們整理相關文獻，對此類病例的治療提出幾點建議：（1）高濃度兒茶酚胺（catecholamine）可能造成心肌壞死，應慎重使用；（2）避免使用H阻斷劑；（3）可攷慮使用主動脈氣球幫浦或amrinone。

關鍵字

過敏反應 ； 急性腑肺水腫 ； 心肌抑制

並列摘要

Cardiac involvement in anaphylaxis has been recognized for a long tune. There have been several clinical articles reporting cardiac changes in human anaphylaxis, mostly manifested as arrhythmia or ischemic changes on electrocardiograms. However, many of these previous reports had problems in attributing a direct anaphylactic effect to the heart, and rarely was a direct myocardial depression reported. We report the case of a patient with rapidly reversible myocardial dysfunction and acute pulmonary edema during an episode of anaphylaxis caused by an insect bite. The medical literature that pertains to this phenomenon is discussed.

並列關鍵字

anaphylaxis ； acute pulmonary edema ； myocardial depression