Hölz W, Ludwig A, Forst H
Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg.
Anaesthesist. 2002 Mar;51(3):187-90. doi: 10.1007/s00101-002-0284-y.
Glucocorticoids are frequently used in clinical anaesthesiology and intensive care because of their antiallergic, antiinflammatory and antioedematous properties and anaphylactic reactions are rare. We report on a 62-year-old asthmatic patient with evidence of aspirin sensitivity. We administered 100 mg of hydrocortisone-21-hemisuccinate (Pharmacia & Upjohn, Erlangen, Germany) dissolved in 100 ml 0.9% sodium chloride solution for perioperative corticoid substitution. The patient immediately developed severe bronchospasm and anaphylactic shock requiring intubation and mechanical ventilation. He received adrenaline, isoflurane, ketamine and inhalational fenoterol. He then developed atrioventricular block type III for which we transcutaneously paced the patient. Subsequently he was tested via skin prick tests, intracutaneous tests and i.v.-challenges resulting in the patient having positive reactions to hydrocortisone-21-hemisuccinate. Thus when allergic-like reactions result from glucocorticoid therapy one should consider corticoid allergy as a differential diagnosis.
由于具有抗过敏、抗炎和抗水肿特性，糖皮质激素在临床麻醉学和重症监护中经常使用，且过敏反应罕见。我们报告一例62岁有阿司匹林敏感性证据的哮喘患者。我们给予100mg氢化可的松21 - 半琥珀酸酯（德国埃尔兰根的法玛西亚公司生产），溶于100ml 0.9%氯化钠溶液中用于围手术期皮质激素替代。患者立即出现严重支气管痉挛和过敏性休克，需要插管和机械通气。他接受了肾上腺素、异氟烷、氯胺酮和吸入用非诺特罗治疗。随后他出现了三度房室传导阻滞，为此我们对患者进行了经皮起搏。随后通过皮肤点刺试验、皮内试验和静脉激发试验对他进行检测，结果该患者对氢化可的松21 - 半琥珀酸酯呈阳性反应。因此，当糖皮质激素治疗导致类似过敏反应时，应将皮质激素过敏作为鉴别诊断考虑。
