Ikeda Nahomi, Oda Yutaka, Tanaka Katsuaki, Nakamura Taketo, Asada Akira
Department of Anesthesiology, Osaka City University Graduate School of Medicine, Osaka 545-8586.
Masui. 2010 Oct;59(10):1294-7.
We report a 39-year-old woman who showed intraoperative anaphylactic shock during elective cesarean section in the 38th week of pregnancy. She underwent cesarean sections under general anesthesia at 33 years of age, and under spinal anesthesia at 37 years without any complication; other past history was unremarkable. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine 2.5 ml and analgesia level up to T2 was obtained 12 minutes later. The operation was uneventful at the birth of a neonate weighing 2700 g delivered with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Drip infusion of oxytocin was started after the delivery and uterine contraction was good. Five minutes later, blood pressure decreased abruptly to 70/40 mmHg, heart rate increased to 130 beats min(-1) and the patient complained of chest discomfort. Bolus injections of ephedrine and phenylephrine were ineffective, and continuous infusion of adrenaline was started to maintain blood pressure. The operation was finished and the patient was intubated for artificial ventilation to prevent airway obstruction. The tracheal tube was removed the following day and the postoperative course was uneventful thereafter. Plasma tryptase levels at 1 and 6 hours after the episode of hypotension were 9.0 and 1.3 ng x ml(-1). Postoperative blood tests revealed an increase in latex-specific immunoglobulin E, suggesting that anaphylactic shock was induced by latex.
我们报告一名39岁女性，在妊娠38周择期剖宫产术中发生术中过敏性休克。她33岁时在全身麻醉下进行剖宫产，37岁时在腰麻下进行剖宫产，均无任何并发症；其他既往史无异常。使用0.5%重比重布比卡因2.5 ml进行腰麻，12分钟后镇痛平面达到T2。分娩一名体重2700 g的新生儿，1分钟和5分钟时阿氏评分分别为8分和9分，手术过程顺利。分娩后开始静脉滴注缩宫素，子宫收缩良好。5分钟后，血压突然降至70/40 mmHg，心率增至130次/分钟，患者主诉胸部不适。静脉推注麻黄碱和去氧肾上腺素无效，开始持续输注肾上腺素以维持血压。手术结束后，患者进行气管插管以进行人工通气，防止气道阻塞。次日拔除气管导管，此后术后过程顺利。低血压发作后1小时和6小时的血浆类胰蛋白酶水平分别为9.0和1.3 ng/ml。术后血液检查显示乳胶特异性免疫球蛋白E升高，提示过敏性休克由乳胶诱发。
