青霉素皮试假阳性的原因分析及对策

目的：通过青霉素皮试假阳性的原因分析，采取相应的对策，较少青霉素皮试假阳性的因素的发生。方法：通过对2625例青霉素皮试中158例假阳性病人的观察并采取有效的护理措施。结论：医护人员加强责任心，在操作上准确掌握皮试液的剂量、浓度，严格操作规程，对可疑阳性者作对照试验，有效避免和减少青霉素皮试假阳性的出现。     

浅谈影响青霉素皮试结果的相关因素

[目的]探讨影响青霉素皮试结果的相关因素.[方法]对7 211例行青霉素皮试的患者进行观察分析.[结果]7 211例中,青霉素皮试阳性者112例,阳性率为1.55%;阴性者7 081例,阴性率为98.20%;皮试判断阴性但青霉素使用后出现不同程度的过敏反应者为假阴性[1],共18例,假阴性发生率为0.25%;皮试结果介于阳性与阴性之间,青霉素使用后无过敏反应者为假阳性[2],共215例,假阳性发生率为2.98%.[结论]两组消毒剂之间的阴性、阳性、假阴性率无显著性差异,P＞0.05;两组消毒剂之间的假阳性率有显著性差异,P＜0.01.通过对影响青霉素皮试结果相关因素的分析,以降低皮试假阴性率、假阳性率,提高青霉素皮试结果判断的准确率.     

浅谈影响青霉素皮试结果的相关因素

犤目的犦探讨影响青霉素皮试结果的相关因素。犤方法犦对7211例行青霉素皮试的患者进行观察分析。犤结果犦7211例中,青霉素皮试阳性者112例,阳性率为1.55%;阴性者7081例,阴性率为98.20%;皮试判断阴性但青霉素使用后出现不同程度的过敏反应者为假阴性犤1犦,共18例,假阴性发生率为0.25%;皮试结果介于阳性与阴性之间,青霉素使用后无过敏反应者为假阳性犤2犦,共215例,假阳性发生率为2.98%。犤结论犦两组消毒剂之间的阴性、阳性、假阴性率无显著性差异,P>0.05;两组消毒剂之间的假阳性率有显著性差异,P<0.01。通过对影响青霉素皮试结果相关因素的分析,以降低皮试假阴性率、假阳性率,提高青霉素皮试结果判断的准确率。     

2种皮试方法假阳性率的比较与分析

目的:评价快速无痛过敏皮试仪做皮试的准确性。方法:在同一个患者身上使用同一批号的青霉素类或头孢类药物,同时作传统的针刺皮试和皮试仪皮试,以比较2种皮试法的假阳性结果差异。结果:273例患者中,2种皮试方法均阳性者18例,2种方法均阴性者210例,传统皮试法假阳性,皮试仪皮试法阴性者40例,传统皮试法阴性,皮试仪皮试法阳性者5例。结论:快速无痛过敏皮试对青霉素类和头孢类药物的假阳性率明显低于针刺皮试,快速过敏皮试准确、无痛、省时、高效。     

青霉素皮试假阳性分析

在基层医院,青霉素类抗生素在临床最为常用.近几年来,部分医务人员顾虑青霉素过敏反应、怕发生医疗事故,任意放宽青霉素皮试阳性的判断标准,出现了很多似阳性,致使本来可以选用青霉素类药物的患者不能应用,疗效受到了影响.我院近5年来,对50例青霉素假阳性患者进行再皮试,发现阳性者仅10例.     

青霉素皮试假阳性反应的原因与斟别对策

<正> 青霉素皮试假阳性反应在临床工作中经常遇到,我院对500例青霉素皮试患者进行临床观察,结果皮试阴性86％,阳性4.8％,假阳性9.2％,现就其假阳性反应的原因作一分析,以探讨对假阳性反应的斟别对策,为临床提供高效价廉的治疗手段。 一、临床资料。①一般资料 46例青霉素皮试假阳性患者男24例,女22例,年龄最大64岁,最小4个月,平均年龄24.2±0.4岁,有青霉素皮试阳性史而从未用过青霉素者31例(占67.4％);青霉素皮试阴阳交替出     

降低小儿青霉素皮试假阳性率的临床护理探讨

为了探讨降低小儿青霉素皮试假阳性率的临床护理对策,本文对小儿青霉素皮试假阳性的原因进行了分析,表明小儿青霉素皮试假阳性与消毒剂、皮试液、年龄、气候等因素密切相关,护理工作者要有高度的责任感,时刻牢记青霉素皮试假阳性反应的影响因素,严格技术操作规范,力争把青霉素皮试假阳性率降到最低限度。     

两种先锋V皮试法的临床效果与分析

目的 评价华康牌(广州伟杰华科技发展有限公司生产)快速过敏皮试仪做先锋V皮试的准确性.方法 在同一个病人身上使用同一批号的先锋V,同时做传统的皮试和皮试仪皮试,比较两种皮试法的结果差异.结果 100例患者中两种皮试方法均阳性者1例,两种方法均阴性者97例,传统皮试法假阳性、皮试仪皮试法阴性者2例,传统皮试法阴性、皮试仪皮试法阳性者0例.结论 华康牌快速过敏皮试仪对先锋V皮试准确、无痛、省时、高效.     

消毒液对小儿青霉素皮试假阳性临床研究

青霉素族药物为小儿最主要和使用最多的抗生素。由于小儿本身的特点。临床上常出现皮试阳性率普遍偏高。从而给小儿用药受到限制。为了探讨和解决这一问题 ,我们自 1996年 6月设计了对 5岁以下小儿在用 75 %酒精消毒皮试结果判断为阳性者 ,再用 0 1%新洁尔灭液在对侧手相同部位消毒行皮内试验观察 ,对其结果进行真 ,假阳性的判断。截止 1998年 6月共观察 2 0 0例患儿。对酒精消毒阳性 ,而新洁尔灭消毒结果是阴性者 ,应用青霉素药物治疗。无 1例发生过敏反应     

2种头孢唑啉钠皮试法的临床效果观察与分析

目的:评价华康牌Ⅱ型(广州伟杰华科技发展有限公司生产)快速过敏皮试仪做头孢唑啉钠皮试的准确性.方法:在同一个病人身上使用同一批号的头孢唑啉钠,同时作传统的皮试和皮试仪皮试,以比较2种皮试法的结果差异.结果:267例患者中2种皮试方法均阳性者1例,2种方法均阴性者263例,传统皮试法假阳性、皮试仪皮试法阴性者3例,传统皮试法阴性、皮试仪皮试法阳性者0例.结论:华康牌Ⅱ型快速过敏皮试仪对头孢唑啉皮试准确、无痛、省时、高效.     

Lymphocyte transformation studies in drug hypersensitivity

In a group of patients with clinically diagnosed drug hypersensitivity the in vitro lymphocyte response to the suspected drug was assessed by the lymphocyte transformation test. The test gave positive results in all 15 patients with penicillin-induced immediate or accelerated allergic reactions and positive immediate skin-test reactivity to the major or the minor antigenic determinant of penicillin, or both, but in only 3 of the 12 patients with delayed-onset maculopapular rashes induced by penicillin, despite positive immediate reactivity to the skin-test reagents.

Lymphocyte stimulation greater than five times the control level was demonstrated for five patients with penicillin-induced erythroderma, Stevens-Johnson syndrome or a serum-sickness-like illness, or with methicillin-induced interstitial nephritis, all of whom had negative reactions to the appropriate skin-test reagents. A low level of stimulation was seen in eight other skin-test-negative patients with possible allergic reactions induced by penicillins. However, in all subjects tested the stimulation was significantly greater than the mean for control subjects.

For 9 of 11 patients with isoniazid-induced hepatitis or maculopapular rashes, but for only 8 of 31 patients with eruptions induced by a variety of drugs other than penicillins and isoniazid, significant stimulation occurred in the lymphocyte transformation test.

It is concluded that the lymphocyte transformation test is useful in the detection of hypersensitivity to the penicillins (although in IgE-mediated reactions skin testing is clearly preferable) and isoniazid but is of limited value in the demonstration of hypersensitivity to other drugs.

     

白内障手术前结膜囊细菌种类及药物敏感性

目的：探讨老年性白内障和合并糖尿病的白内障患者手术前结膜囊细菌种类及药物敏感性。方法进行病例对照研究。整群选取2014年5月—2015年12月在该院手术的白内障患者178例（200只眼）作为研究对象,其中老年性白内障89例(100只眼)和合并糖尿病的白内障患者89例（100只眼）,对术前患者结膜囊取材进行细菌培养,并观察培养阳性的细菌对临床常用抗生素的敏感性。采用SPSS 13.0统计学软件进行统计学分析。结果老年性白内障和合并糖尿病的白内障患者细菌培养阳性率分别为28%和48%,合并糖尿病的白内障患者细菌培养阳性率显著高于老年性白内障（P<0.01）差异有统计学意义。革兰氏阳性球菌占总检出菌的65%,表皮葡萄球菌检出率最高,其次是金黄色葡萄球菌,革兰氏阴性杆菌列第三位,微球菌属检出率最低。大多数菌株对氧氟沙星、妥布霉素、万古霉素、新霉素敏感性较好,对妥布霉素、环丙沙星耐药率分别为11%和9%,大多数革兰氏阳性球菌对庆大霉素、红霉素、青霉素耐药性下降。结论合并糖尿病的白内障患者是感染发生的高危人群,合理使用抗菌药物,是降低和避免感染的有效手段。     

青霉素特异性IgE检测及其临床意义

利用单克隆抗体及生物素－亲和素放大系统检测青霉素抗原特异性ＩｇＥ，并探讨其临床意义。结果５９例青霉素Ⅰ型变态反应患者中青霉素特异性ＩｇＥ总阳性率为８８．１１％（５２／５９）；１４例门诊皮试假阳性患者特异性ＩｇＥ阴性，使用青霉素无不良反应；９例猩红热样皮疹青霉素过敏患者中１例特异性ＩｇＥ阳性；而３１５例非青霉素过敏者，其ＢＰＯ特异性ＩｇＥ均阴性，且其中部分患者使用青霉素亦无过敏反应。本文方法有特异性强、敏感性较高的特点。     

The rational clinical examination. Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy

CONTEXT: Clinicians frequently withhold antibiotics that contain penicillin based on patients' self-reported clinical history of an adverse reaction to penicillin and the clinicians' own misunderstandings about the characteristics of a true penicillin allergy. OBJECTIVES: To determine the likelihood of true penicillin allergy with consideration of clinical history and to evaluate the diagnostic value added by appropriate skin testing. DATA SOURCES: MEDLINE was searched for relevant English-language articles dated 1966 to October 2000. Bibliographies were searched to identify additional articles. STUDY SELECTION: We included original studies describing the precision of skin testing in diagnosis of penicillin allergy. We excluded studies that did not use both minor and major determinants, provide an explicit definition of penicillin allergy, or list the specific criteria necessary for a positive skin test result. Fourteen studies met the inclusion criteria. DATA EXTRACTION: Three authors independently reviewed and abstracted data from all articles and reached consensus about any discrepancies. DATA SYNTHESIS: Patients' self-reported history has low accuracy for diagnosis of true penicillin allergy. By evaluating studies comparing clinical history to the skin test for penicillin allergy among patients with and without a positive history for penicillin allergy, positive and negative likelihood ratios were calculated. History of penicillin allergy had a positive likelihood ratio of 1.9 (95% confidence interval [CI], 1.5-2.5), while absence of history of penicillin allergy had a negative likelihood ratio of 0.5 (95% CI, 0.4-0.6). CONCLUSIONS: Only 10% to 20% of patients reporting a history of penicillin allergy are truly allergic when assessed by skin testing. Taking a detailed history of a patient's reaction to penicillin may allow clinicians to exclude true penicillin allergy, allowing these patients to receive penicillin. Patients with a concerning history of type I penicillin allergy who have a compelling need for a drug containing penicillin should undergo skin testing. Virtually all patients with a negative skin test result can take penicillin without serious sequelae.     

妊娠梅毒患者的驱梅治疗及对围产结局的影响

目的:探讨妊娠期驱梅治疗的方法及对围产结局的影响。方法:选取89例妊娠期合并梅毒孕妇,依据确诊梅毒及首次注射首剂青霉素治疗时间分为3组,其中在妊娠早期(孕周≤12周)24例为早孕组,妊娠中期(12周<孕周<29周)31例为中孕组,妊娠晚期(孕周≥29周)34例为晚孕组,给予规范苄星青霉素或红霉素治疗,观察围产儿预后。结果:早孕组及中孕组产妇不良妊娠结局发生率分别为8.33%、19.35%,明显低于晚孕组(52.94%),差异具有统计学意义(P<0.05);89例孕妇根据初次检测RPR滴度不同分组,其中滴度≤1∶4者53例,滴度≥1∶8者36例,滴度≤1∶4者新生儿不良预后发生率为7.55%,明显低于滴度≥1∶8孕妇分娩的新生儿不良预后发生率(27.18%),差异具有统计学意义(P<0.05),先天性梅毒患病率分别为3.22%、22.77%,差异具有统计学意义(P<0.05);早孕组孕妇分娩新生儿RPR阳性率为20.83%,先天性梅毒患病率为0,中孕组分别为19.35%、3.23%,晚孕组分别为70.59%、26.47%,早孕组及中孕组RPR阳性率、先天性梅毒患病率明显低于晚孕组,差异具有统计学意义(P<0.05)。结论:妊娠合并梅毒孕妇采取驱梅治疗时机与围产儿的预后及先天性梅毒患病率密切相关,早期正规进行驱梅治疗能明显改善围产儿预后,降低先天性梅毒发生率。     

354例中药注射剂不良反应报告分析

目的了解中药注射剂不良反应发生的特点,为临床合理用药提供依据。方法收集本院2007～2010年354例ADR报告,从患者的年龄、性别、民族、体重、家族史、既往史、药品名称、所涉及的器官及系统、临床表现、国内文献及说明书记载、不良反应关联性评价等方面进行分析。结果 354例报告中涉及38种中药注射剂,50岁以上患者发生率最高(58.19%),刺五加注射液引起不良反应所占比例最大(10.73%),ADR临床表现主要为皮疹和瘙痒(41.24%),中药注射剂用于循环系统疾病产生的不良反应最高(21.75%)。结论中药注射剂不良反应产生的原因多样,应加强药物不良反应监测,提高临床安全用药水平。     

青霉素皮试假阳性原因及预防对策的探讨

目的:探讨如何降低青霉素皮试结果假阳性。方法:回顾性分析3 780例青霉素皮试的临床资料。结果:3 780例皮试结果中阴性3 260例,阳性100例,可疑阳性420例(其中假阳性380例)。结论:青霉素假阳性与患者年龄、性别、皮试时间及护理人员操作方法等有关,必须加强职业道德教育,提高业务技术水平,降低青霉素皮试假阳性,安全地扩大青霉素的使用范围。     

Radioallergosorbent testing for penicillin allergy in family practice.

OBJECTIVES: To determine (a) the prevalence of patients supposedly allergic to penicillin who have a positive radioallergosorbent test (RAST) result for penicillin G or V and (b) the predictive power of family physicians' clinical judgement that a patient who is supposedly allergic to penicillin will have a positive RAST result. DESIGN: Prospective multicentre cross-sectional observational study. SETTING: Eleven primary care practices in Newfoundland; 10 were in a rural setting. PATIENTS: Of 110 consecutive adult patients with a supposed allergy to penicillin 97 agreed to participate in the study; 92 underwent RAST. INTERVENTIONS: Patients helped physicians complete a questionnaire and had a venous blood sample taken for the RAST. Physicians examined the clinical history and judged whether the patient was likely to have a positive RAST result. MEAN OUTCOME MEASURES: Rates of positive and negative RAST results for penicillin V and G. RESULTS: Of the 92 patients 8 had a positive RAST result and 84 a negative one. The positive predictive power of a "good" clinical history (e.g., urticaria, swollen eyes, tongue or lips, or an anaphylactic reaction witnessed by a physician) was low (10%); the negative predictive power of a "poor" clinical history (e.g., nausea, vomiting, diarrhea, fever, nonspecific rash or fainting) was 92%. CONCLUSIONS: Less than 10% of primary care patients with a supposed allergy to penicillin will have a positive RAST result. In addition, physicians' predictions of allergy in such patients are imprecise.     

医院无关联标本艾滋病病毒(HIV)筛查检测结果分析

目的选择2005-2010年本院初筛实验室样本阳性反应资料分析,了解我院住院病人中HIV感染状况,了解我市艾滋病感染情况,为流行病学采取有效防控措施提供科学依据。方法对2005-2010年我院住院病人采取自愿常规免费的原则进行HIV抗体检测,同时对HIV抗体阳性者采集其吸毒史、不洁性行为史。结果 2005-2010年共筛查检测48 241例,其中手术病人31 971例、非手术病人16 270例,检测率100%。HIV抗体初筛查结果阳性131例,阳性率为0.27%。年龄均在20～89岁之间,发病率呈阶梯样上升。HIV感染方式以性传播为主。结论对住院病人进行HIV检测是发现HIV感染者重要手段之一,同时为医务人员避免职业暴露感染HIV提供信息提前作好防护工作,也为流行病学采取预防控制措施提供科学依据均有现实意义。     

青霉素过敏试验皮试仪与皮内注射的对比研究

目的：研究快速青霉素过敏皮试仪在临床应用中的安全性。方法：从2004年2月至2007年12月随机选取在我院治疗的12669例患者,并随机分为皮试仪组和皮内注射组,对比结果。结果：皮试仪组6341例,阳性38例,阳性率0．6％;皮内注射组6328例,阳性262例,阳性率4．14％,两组皮试阳性率有显著差异,根据皮试结果用药,均无严重不良反应发生。结论：青霉素快速过敏皮试仪方法简便、无痛、所需时间短、安全性强,准确性高,使用效果好,可代替皮内注射法,适合推广应用。