Escolano F, Valero A, Huguet J, Baxarias P, de Molina M, Castro A, Granel C, Sanosa J, Bartolomé B
Servicios de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Mar-Esperança (IMAS), Passeig Marítim 25-29, 08003 Barcelona.
Rev Esp Anestesiol Reanim. 2002 Jun-Jul;49(6):286-93.
To determine the incidence, immunological mechanisms, severity and clinical course of perioperative allergic reactions.
Prospective epidemiological study lasting 2 years (1996-97). In 20 hospitals in Catalonia (Spain), we studied patients who suffered allergic reactions equal to or greater than grade Ib according to the classification of Laxenaire. Serum and urine samples were collected during the first and sixth hours after the onset of a reaction. Complement factors, total serum and latex-specific serum IgE antibodies, hemostatic markers, serum tryptase and urinary methylhistamine were assayed. Tests for allergy to the drugs used during the perioperative period were performed on all patients who consented.
Anesthetic procedures were performed 328,430 times in the 20 hospitals. Thirty-two allergic reactions were reported (1 case/10,263 anesthesias); the frequency was greater during general anesthesia (1 case/6,978 anesthesias). Women suffered 58.3% of the reactions, and the mean patient age was 47.8 +/- 16.5 years. Fifty-six percent of the reactions were severe (grades III-IV), and 68.7% occurred upon immediate exposure. Induction was the moment of greatest risk (50%). Treatment was required by 90.6% of the patients, but no deaths or serious sequelae occurred. Complete analyses could be carried out immediately for 25 patients. High urinary methylhistamine and/or serum tryptase levels were found for 57% of the patients with grade Ib reactions, for 80% of those with grade II reactions, and for 91.7% of those with grade III reactions (p = 0.05). High serum tryptase levels were the only findings for 53.8% of the grade III reactions (p = 0.007). Skin tests were positive for 62.5% of the patients.
The frequency of allergic reactions in Catalonia is 1 case per 10,263 anesthesias performed, but the rate is higher in general anesthesia. Fifty-six percent of the reactions were severe. Most developed immediately and the moment of induction involved the greatest risk. Early assessment of methylhistamine and tryptase levels has been shown to be useful and positivity is linearly associated with severity of reaction. In 62.5% of the patients, positive results were seen in skin tests performed later.
确定围手术期过敏反应的发生率、免疫机制、严重程度及临床病程。
一项为期2年(1996 - 1997年)的前瞻性流行病学研究。在加泰罗尼亚(西班牙)的20家医院,我们研究了根据拉克塞纳尔分类法发生等于或大于Ib级过敏反应的患者。在反应发生后的第1小时和第6小时采集血清和尿液样本。检测补体因子、血清总IgE和乳胶特异性血清IgE抗体、止血标志物、血清类胰蛋白酶和尿甲基组胺。对所有同意的患者进行围手术期所用药物的过敏试验。
20家医院共进行了328,430次麻醉操作。报告了32例过敏反应(1例/10,263次麻醉);全身麻醉期间的发生率更高(1例/6,978次麻醉)。女性发生反应的比例为58.3%,患者平均年龄为47.8±16.5岁。56%的反应为重度(III - IV级),68.7%发生在即刻接触时。诱导期是风险最高的时刻(50%)。90.6%的患者需要治疗,但未发生死亡或严重后遗症。对25例患者可立即进行完整分析。Ib级反应患者中有57%、II级反应患者中有80%、III级反应患者中有91.7%的尿甲基组胺和/或血清类胰蛋白酶水平升高(p = 0.05)。53.8%的III级反应患者仅血清类胰蛋白酶水平升高(p = 0.007)。62.5%的患者皮肤试验呈阳性。
加泰罗尼亚过敏反应的发生率为每10,263次麻醉中有1例,但全身麻醉时发生率更高。56%的反应为重度。大多数反应即刻发生,诱导期风险最高。已证明早期评估甲基组胺和类胰蛋白酶水平是有用的,其阳性结果与反应严重程度呈线性相关。在62.5%的患者中,后期进行的皮肤试验呈阳性。