对有食物过敏风险的儿童和青少年，肾上腺素自动注射器针长度是否不合适？
2016/05/26
摘要
背景：食物过敏是儿童最常见的过敏反应。肾上腺素自动注射器（EAI）肌内注射是治疗过敏性反应的标准护理。我们研究了在北美和欧洲体重在15-30公斤和30公斤以上的有过敏风险的儿童和青少年是否能接受目前的EAI肾上腺素肌内注射。
方法：采用高压（最大）或低压（最小）超声波来测量102名体重在15-30公斤的儿童（组1）和100名体重超过30公斤的儿童和青少年（组2）在右大腿前外侧中间三分之一处从皮肤到肌肉的距离（STMD）和皮肤到骨头的距离骨（STBD）。
结果：第一组中11% （11/102）的孩子使用高压EAI（HPEAI）Epipen Jr(®) 和 Auvi-Q(®)/Allerject(®) 0.15 mg，38%的孩子（38/102）用另一种HPEAI，Jext（®），他们有最大的STMD，这显示出肌内注射的风险。而使用这些装置进行皮下注射有1%的风险。使用低压EAI(LPEAI) Emerade(®)进行肌内注射没有风险。在组2中，用HPEAI进行肌内注射有3%的风险，而用LPEAI则没有风险。然而，用HPEAI进行皮下注射有9%的风险，但用LPEAT进行皮下注射时风险为2%。
结论：在有过敏反应的风险的儿童中使用HPEAI (Epipen(®)/Epipen Jr(®)，Auvi-Q(®)/Allerject(®)，特别是Jext(®))进行肌内注射有风险，用目前使用的HPEAI对儿童和青少年进行皮下注射也同样有风险。
（苏欣 审校）
Allergy Asthma ClinImmunol. 2016 Mar 6;12:11.doi:10.1186/s13223-016-0110-8. eCollection 2016.
Do epinephrine auto-injectors have an unsuitable needle length in children and adolescents at risk for anaphylaxis from food allergy?
Dreborg S1, Wen X2, Kim L3, Tsai G4, Nevis I5, Potts R6, Chiu J4, Dominic A7, Kim H8.
Author information
Abstract
BACKGROUND:Food allergy is the most common cause of anaphylaxis in children. Intramuscular delivery of epinephrine auto-injectors (EAI) is the standard of care for the treatment of anaphylaxis. We examined if children and adolescents at risk of anaphylaxis weighing 15-30 kg and >30 kg would receive epinephrine into the intramuscular space with the currently available EAI in North America and Europe.
METHODS:The distance from skin to muscle (STMD) and skin to bone (STBD) on the mid third anterolateral area of the right thigh was measured by ultrasound applying either high pressure (max) or slight pressure (min) in 102 children weighing 15-30 kg (group 1) and 100 children and adolescents, weighing more than 30 kg (group 2).
RESULTS:Using a high pressure EAI (HPEAI), Epipen Jr(®) and Auvi-Q(®)/Allerject(®) 0.15 mg, 11/102 (11 %) children in group 1 and 38/102 (38 %) using another HPEAI, Jext(®), had a STMDmax that showed a risk of intraosseous injection. There was a 1 % risk of subcutaneous injection with these devices. There was no risk of intraosseous injection using a low pressure EAI (LPEAI), Emerade(®). In group 2, the risk of intraosseous injection using a HPEAI was 3 % and no risk using a LPEAI. However, the risk of subcutaneous injection using HPEAI was 9 % and using LPEAI was 2 %.
CONCLUSION:There is a risk of intraosseous injection using HPEAI (Epipen(®)/Epipen Jr(®), Auvi-Q(®)/Allerject(®) and especially Jext(®)) in children at risk of anaphylaxis. There was also a risk of subcutaneous injection using the currently available HPEAI in children and adolescents.
KEYWORDS:Allergy; Anaphylaxis; Epimysium; Epinephrine; Epinephrine auto-injector; Food allergy; Intramuscular; Skin to bone distance; Skin to muscle distance; Subcutaneous
Allergy Asthma ClinImmunol. 2016 Mar 6;12:11.doi:10.1186/s13223-016-0110-8. eCollection 2016.
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