1例罕见肺曲霉菌病患者迟发过敏反应护理体会

肺曲霉菌病是由曲霉菌属真菌引起的一系列感染性肺部疾病,曲霉菌是条件致病性真菌,其孢子普遍存在于空气中,通过吸入曲霉分生孢子而致病,是一种深部真菌感染疾病_^[1]。在临床诊疗中,病毒性肺部感染的患者合并肺曲霉菌病较为多见。在治疗合并肺曲霉菌需要联合使用多种抗生素,本次报道是使用青霉素后发生的迟发性过敏反应。青霉素药物的变态反应是较为多见的药物不良反应事件,过敏性休克等严重的变态反应已经受到广泛重视,但是迟发性过敏反应受到的关注较少。迟发性过敏反应是由T淋巴细胞介导的一种超敏反应,在变应原作用下形成致敏淋巴细胞,当再次接触相同变应原时,可表现出一种迟缓的(至少约12小时后才出现反应,24～72小时达高峰)、以单个核细胞浸润和细胞变性坏死为特征的局部变态反应性炎症。此反应具有一定的隐蔽性和不可预见性,也会对患者造成巨大的损害,甚至威胁到生命_^[2]。本次报道1例合并肺曲霉菌感染患者使用青霉素发生迟发性过敏反应引起的严重的过敏性药疹_^[3],通过皮肤护理及严密的病情及药物的观察、消毒隔离、心理干预,患者治愈出院,本案例较为罕见,现将护理体会报道如下。

Nursing experience of delayed allergic reaction in a patient with rare pulmonary aspergillosis

PenicPulmonary aspergillus disease is a series of infectious pulmonary diseases caused by fungi of the genus Aspergillus. Aspergillus is a conditionally pathogenic fungus whose spores commonly exist in the air and are caused by inhalation of aspergillus conidia. It is a deep fungal infection disease _^[1]. In clinical diagnosis and treatment, pulmonary aspergillosis in patients with viral pulmonary infection is more common. A combination of antibiotics is required for the treatment of pulmonary aspergillus, and delayed anaphylaxis is reported after the use of penicillin. Allergic reactions to penicillin drugs are the most common adverse drug reactions. Severe allergic reactions such as anaphylaxis have been widely paid attention to, but delayed allergic reactions have received less attention. Late-onset allergic reactions is mediated by T lymphocyte an allergic reaction, in under the action of allergen sensitization lymphocytes, when contact with the same allergen again, can show a kind of slow (about 12 hours after the reaction, at least 24 ~ 72 hours of peak), with a single nuclear cell infiltration, and characterized by the death of cells in allergic inflammation. This reaction has certain concealment and unpredictability, and will also cause great damage to patients and even threaten their lives _^[2]. This report reports a patient with pulmonary aspergillus infection with severe allergic drug eruption caused by delayed allergic reaction caused by penicillin _^[3]. The patient was cured and discharged from hospital through skin care, rigorous condition and drug observation, disinfection and isolation, and psychological intervention. This case is relatively rare, and the nursing experience is reported as follows.