• 四川大學(xué)華西醫(yī)院腎臟內(nèi)科,成都610041;

盡管維生素K1過敏臨床罕見,但我科近期在腎活檢前肌注維生素K1后先后發(fā)生了4例過敏反應(yīng).為提供最佳證據(jù)指導(dǎo)臨床治療,作者對MEDLINE數(shù)據(jù)庫(截至2005年5月)中有關(guān)維生素K1過敏的研究進(jìn)行了檢索和評價.結(jié)果發(fā)現(xiàn),維生素K1過敏的相關(guān)研究僅為個案報告或回顧性分析.其主要反應(yīng)為過敏性皮炎,皮疹表現(xiàn)多樣,出現(xiàn)和持續(xù)時間不一,而過敏性休克等嚴(yán)重副反應(yīng)極少發(fā)生.在腎活檢前常規(guī)使用維生素K1應(yīng)注意以下幾點: ①對于并無維生素K1缺乏或低凝血酶原血癥的患者不必常規(guī)使用,尤其是在用于非促進(jìn)止血用途時應(yīng)盡可能換用其他作用相似的藥物; ②如果確有必要使用,在非緊急情況下應(yīng)盡量避免靜脈內(nèi)使用; ③維生素K1過敏的發(fā)生率不高且程度較輕,因此不推薦在使用該藥的同時常規(guī)使用抗組胺藥物和糖皮質(zhì)激素.同時應(yīng)加強藥物不良反應(yīng)的監(jiān)測工作.

引用本文： 李 孜,付 平,周 莉,劉先蓉,黃頌敏. 肌肉注射維生素K1過敏的臨床證據(jù). 中國循證醫(yī)學(xué)雜志, 2005, 05(8): 641-643. doi: 復(fù)制

1. Riegert-Johnson DL, Volcheck GW. The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review[J]. Ann Allergy Asthma Immunol, 2002; (4): 400-406.
2. Sommer S, Wilkinson SM, Peckham D, Wilson C. Type IV hypersensitivity to vitamin K [J]. Contact Dermatitis, 2002 ; 46(2): 94-96.
3. Gettler SL, Fung MA. Off-center fold: indurated plaques on the arms of a 52-year-old man. Diagnosis: Cutaneous reaction to phytonadione injection [J]. Arch Dermatol, 2001; 137(7): 957-962.
4. Wilkins K, DeKoven J, Assaad D.Cutaneous reactions associated with vitamin K1 [J]. J Cutan Med Surg, 2000; 4(3): 164-168.
5. Wong DA, Freeman S. Cutaneous allergic reaction to intramuscular vitamin K1 [J]. Australas J Dermatol, 1999; 40(3): 147-152.
6. Balato N, Cuccurullo FM, Patruno C, Ayala F. Adverse skin reactions to vitamin K1: report of 2 cases [J]. Contact Dermatitis, 1998; 38(6): 341-342.
7. Moreau-Cabarrot A, Giordano-Labadie F, Bazex J. Cutaneous hypersensitivity at the site of injection of vitamin K1 [J]. Ann Dermatol Venereol, 1996; 123(3): 177-179.
8. Bruynzeel I, Hebeda CL, Folkers E, Bruynzeel DP.Cutaneous hypersensitivity reactions to vitamin K: 2 case reports and a review of the literature [J]. Contact Dermatitis, 1995; 32(2): 78-82.
9. Guidetti MS, Vincenzi C, Papi M, Tosti A.Sclerodermatous skin reaction after vitamin K1 injections[J]. Contact Dermatitis, 1994; 31(1): 45-46.
10. Lemlich G, Green M, Phelps R, Lebwohl M, Don P, Gordon M.Cutaneous reactions to vitamin K1 injections [J]. J Am Acad Dermatol, 1993; 28(2 Pt 2): 345-347.
11. Tuppal R, Tremaine R. Cutaneous eruption from vitamin K1 injection [J]. J Am Acad Dermatol, 1992; 27(1): 105-106.
12. Martinez-Abad M, Delgado F, Palop V, Morales-Olivas FJ. Vitamin K1 and anaphylactic shock[J]. DICP, 1991; 25(7-8): 871-872.
13. Allue Bellosta L, Iniguez Navarro D, Peyri Rey J.A localized skin reaction caused by intramuscular vitamin K1 [J]. Rev Clin Esp, 1989; 185(4): 217-218.
14. de la Rubia J, Grau E, Montserrat I, Zuazu I, Paya A. Anaphylactic shock and vitamin K1 [J]. Ann Intern Med, 1989; 110(11): 943.
15. Anderson TH, Hindsholm KB, Fallingborg J. Severe complication to phytomenadione after intramuscular injection in woman in labor. Case report and review of literature [J]. Acta Obstet Gynecol Scand, 1989; 68(4): 381-382.
16. Finkelstein H, Champion MC, Adam JE. Cutaneous hypersensitivity to vitamin K1 injection[J]. J Am Acad Dermatol, 1987; 16(3 Pt 1): 540-545.
17. Havel M, Muller M, Graninger W, Kurz R, Lindemayr H. Tolerability of a new vitamin K1 preparation for parenteral administration to adults: one case of anaphylactoid reaction [J]. Clin Ther, 1987; 9(4): 373-379.
18. Janin-Mercier A, Mosser C, Souteyrand P, Bourges M.Subcutaneous sclerosis with fasciitis and eosinophilia after phytonadione injections [J]. Arch Dermatol, 1985; 121(11): 1421-1423.
19. Robison JW, Odom RB. Delayed cutaneous reaction to phytonadione[J]. Arch Dermatol, 1978; 114(12): 1790-1792.
20. Fiore LD, Scola MA, Cantillon CE, Brophy MT. Anaphylactoid reactions to vitamin K [J]. J Thromb Thrombolysis, 2001; 11(2): 175-183.
  1. 1. Riegert-Johnson DL, Volcheck GW. The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review[J]. Ann Allergy Asthma Immunol, 2002; (4): 400-406.
  2. 2. Sommer S, Wilkinson SM, Peckham D, Wilson C. Type IV hypersensitivity to vitamin K [J]. Contact Dermatitis, 2002 ; 46(2): 94-96.
  3. 3. Gettler SL, Fung MA. Off-center fold: indurated plaques on the arms of a 52-year-old man. Diagnosis: Cutaneous reaction to phytonadione injection [J]. Arch Dermatol, 2001; 137(7): 957-962.
  4. 4. Wilkins K, DeKoven J, Assaad D.Cutaneous reactions associated with vitamin K1 [J]. J Cutan Med Surg, 2000; 4(3): 164-168.
  5. 5. Wong DA, Freeman S. Cutaneous allergic reaction to intramuscular vitamin K1 [J]. Australas J Dermatol, 1999; 40(3): 147-152.
  6. 6. Balato N, Cuccurullo FM, Patruno C, Ayala F. Adverse skin reactions to vitamin K1: report of 2 cases [J]. Contact Dermatitis, 1998; 38(6): 341-342.
  7. 7. Moreau-Cabarrot A, Giordano-Labadie F, Bazex J. Cutaneous hypersensitivity at the site of injection of vitamin K1 [J]. Ann Dermatol Venereol, 1996; 123(3): 177-179.
  8. 8. Bruynzeel I, Hebeda CL, Folkers E, Bruynzeel DP.Cutaneous hypersensitivity reactions to vitamin K: 2 case reports and a review of the literature [J]. Contact Dermatitis, 1995; 32(2): 78-82.
  9. 9. Guidetti MS, Vincenzi C, Papi M, Tosti A.Sclerodermatous skin reaction after vitamin K1 injections[J]. Contact Dermatitis, 1994; 31(1): 45-46.
  10. 10. Lemlich G, Green M, Phelps R, Lebwohl M, Don P, Gordon M.Cutaneous reactions to vitamin K1 injections [J]. J Am Acad Dermatol, 1993; 28(2 Pt 2): 345-347.
  11. 11. Tuppal R, Tremaine R. Cutaneous eruption from vitamin K1 injection [J]. J Am Acad Dermatol, 1992; 27(1): 105-106.
  12. 12. Martinez-Abad M, Delgado F, Palop V, Morales-Olivas FJ. Vitamin K1 and anaphylactic shock[J]. DICP, 1991; 25(7-8): 871-872.
  13. 13. Allue Bellosta L, Iniguez Navarro D, Peyri Rey J.A localized skin reaction caused by intramuscular vitamin K1 [J]. Rev Clin Esp, 1989; 185(4): 217-218.
  14. 14. de la Rubia J, Grau E, Montserrat I, Zuazu I, Paya A. Anaphylactic shock and vitamin K1 [J]. Ann Intern Med, 1989; 110(11): 943.
  15. 15. Anderson TH, Hindsholm KB, Fallingborg J. Severe complication to phytomenadione after intramuscular injection in woman in labor. Case report and review of literature [J]. Acta Obstet Gynecol Scand, 1989; 68(4): 381-382.
  16. 16. Finkelstein H, Champion MC, Adam JE. Cutaneous hypersensitivity to vitamin K1 injection[J]. J Am Acad Dermatol, 1987; 16(3 Pt 1): 540-545.
  17. 17. Havel M, Muller M, Graninger W, Kurz R, Lindemayr H. Tolerability of a new vitamin K1 preparation for parenteral administration to adults: one case of anaphylactoid reaction [J]. Clin Ther, 1987; 9(4): 373-379.
  18. 18. Janin-Mercier A, Mosser C, Souteyrand P, Bourges M.Subcutaneous sclerosis with fasciitis and eosinophilia after phytonadione injections [J]. Arch Dermatol, 1985; 121(11): 1421-1423.
  19. 19. Robison JW, Odom RB. Delayed cutaneous reaction to phytonadione[J]. Arch Dermatol, 1978; 114(12): 1790-1792.
  20. 20. Fiore LD, Scola MA, Cantillon CE, Brophy MT. Anaphylactoid reactions to vitamin K [J]. J Thromb Thrombolysis, 2001; 11(2): 175-183.