【摘要】 目的 总结抗感染中心静脉导管致过敏性休克患者误诊原因及防范措施。方法 回顾性分析2010年8月至2023年11月2例曾误诊的抗感染中心静脉导管致过敏性休克患者的临床资料。结果 1例因烧伤后会阴部等瘢痕挛缩畸形2年入院，拟行会阴部瘢痕切除整形术，置入抗感染中心静脉导管后出现过敏反应，考虑利多卡因或丙泊酚过敏，给予抗过敏治疗后好转。再次拟行双侧腘部瘢痕切除植皮术，置入上述导管后出现过敏性休克，结合2次过敏情况，诊断为抗感染中心静脉导管致过敏性休克。误诊时间17 d。1例高空坠物致左下肢毁损伤并多发骨折、失血性休克1 h入院，经对症处理病情稳定后，拟行皮肤软组织扩创修复术，给予抗感染中心静脉导管置入及头孢呋辛钠静脉滴注，出现过敏反应，考虑头孢呋辛钠过敏，给予抗过敏治疗后好转。再次拟行残余创面植皮术+头皮取皮术，置入上述导管后出现过敏性休克，结合2次过敏情况，诊断为抗感染中心静脉导管致过敏性休克。误诊时间24 d。经及时抢救，2例生命体征平稳，术后好转出院。结论 抗感染中心静脉导管致过敏性休克易误诊，临床应严格选择适应证，详细了解患者病史，置管过程中密切观察病情变化，加强临床医师与麻醉医师沟通有助于防范误诊。更多还原

【Abstract】 Objective To summarize the causes of misdiagnosis and preventive measures in patients with anaphylactic shock caused by anti-infective central venous catheter. Methods From August 2010 to November 2023, the clinical data of 2 patients with anaphylactic shock caused by anti-infective central venous catheter were retrospectively analyzed. Results A patient was hospitalized due to perineal cicatricial contracture deformity after burn for 2 years. After perineal cicatrictomy and plastic surgery was proposed, anaphylaxis occurred after anti-infective central venous catheter was inserted. Considering allergy to Lidocaine or Propofol, the condition was improved after anaphylaxis treatment. Bilateral popliteal scar resection and skin grafting were reperformed, and anaphylactic shock occurred after the above-mentioned catheter was inserted. Considering two allergies, anaphylactic shock caused by anti-infective central venous catheter was diagnosed. The misdiagnosis lasted 17 d. Another patient with left lower limb damage caused by falling material, multiple fractures and hemorrhagic shock for 1 h was admitted to hospital. After symptomatic treatment, the condition was stabilized, skin and soft tissue reconstruction was proposed, anti-infective central venous catheter placement and intravenous infusion of Cefuroxime Sodium were given, and allergic reaction occurred. Considering allergy to Cefuroxime Sodium, the condition was improved after anti-allergic treatment. Residual wound skin grafting + scalp skin extraction was reperformed. Anaphylactic shock occurred after the above-mentioned catheter was inserted. Considering allergy for two times, anaphylactic shock caused by anti-infective central venous catheter was diagnosed. The misdiagnosis lasted 24 d. After timely rescue, the vital signs of the two patients were stable, and they were discharged from hospital after operation. Conclusion Anaphylactic shock caused by anti-infective central venous catheter is prone to misdiagnosis. Strict selection of indications, detailed understanding of patient history, close observation of disease changes during catheterization, and strengthening communication between clinicians and anesthesiologists are all helpful to prevent misdiagnosis.更多还原