Author/Editor     Grosek, Štefan
Title     Sproženje in zdravljenje anafilaktičnega šoka
Translated title     Triggering and treatment of anaphylactic shock
Type     članek
Source     Med Razgl
Vol. and No.     Letnik 38, št. Suppl 7
Publication year     1999
Volume     str. 121-30
Language     slo
Abstract     Anaphylactic shock is a clinical syndrome with a typical clinical picture and course, due to the release and action of histamine and other preformed and newly synthetisized mediators of anaphylaxis, targeting endothelial cell, smooth muscles of bronchi, gut and vessels. After sensitization of the organism, or even without it, if direct injection of allergen into circulation occurs, allergen binds IgE on mastocytes and degranulation and release of histamine ensues together with the generation of new mediators. Some drugs, peptides, venoms and other agents are capable of direct activation of mastocytes bypassing the ligation to IgE. Treatment of anaphylactic shock enconters injection of epinephrine subcutaneously or intramuscularly or even intravenously in most sever causes. In bronchospasm with wheezing an aminophyllin is needed, and after that the patients receives H1- and H2-receptor antagonists and corticosteroids. Aggressive antishock fluid therapy with crystalloid is needed often together with catecholamines in continuous infusion when cardiocirculatory failure is impeding. Treatment should be started immediately and continued in an intensive care unit at least for 48 hours to prevent late reactivation of anaphylactic shock and other complications.
Summary     Anafilaktični šok je klinični sindrom z značilno klinično sliko in potekom, ki je posledica sproščanja in delovanja histamina in ostalih dejavnikov anafilaksije na endotelno celico in gladke mišice bronhov, črevesja in žilja. Po senzibilizaciji organizma ali tudi brez, če gre za neposreden vnos večje količine alergena v obtočila, se alergen veže na IgE na mastocitih, sledi degranulacija in izplavljenje histamina in stvarjenje novih dejavnikov anafilaksije iz celične membrane. Nekatere snovi, npr. zdravila, peptidi, strupi itd., lahko sprožijo anafilaktični šok mimo IgE, z neposrenim aktiviranjem mastocitov. Zdravljenje anafilaktičnega šoka sestoji iz dajanja adrenalina pod kožo ali v mišico ali v težjih primerih neposredno v obtočila, pri piskanju zaradi zoženih dihalnih poti damo aminofilin, nato pa uporabimo tudi H1- in H2-antihistaminike in kortikosteroide. Zaradi nizkega krvnega tlaka je potrebno antišokovno tekočinsko zdravljenje. Dajemo kristaloide, v primerih popuščanja srca in obtočil uporabimo kateholamine v trajni infuziji. Zdravljenje anafilaktičnega šoka naj se začne takoj na mestu dogodka in nadaljuje še najmanj 48 ur v enoti za intenzivno terapijo zaradi možnih zapletov in ponovitev izbruha.
Descriptors     ANAPHYLAXIS
HISTAMINE
RECEPTORS, HISTAMINE
CARDIOPULMONARY RESUSCITATION
HISTAMINE ANTAGONISTS
EPINEPHRINE
FLUID THERAPY
ALLERGENS
HYPERSENSITIVITY, IMMEDIATE
IGE
MAST CELLS