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[2009年日本乳胶过敏学会乳胶过敏安全管理指南]

[2009 Japanese Society of Latex Allergy guidelines for the safe management of latex allergy].

作者信息

Mizuno Ju, In-Nami Hiroshi

机构信息

Department of Anesthesiology, Chiba Nishi General Hospital, Matsudo 270-2251.

出版信息

Masui. 2011 Jun;60(6):753-6.

Abstract

Latex allergy is an IgE-mediated reaction to natural latex antigen. Operating room equipment frequently includes medical devices, such as surgical gloves, intravenous lines, and urinary catheters, which are made from latex or contain latex. These products can trigger an allergic reaction that can result in anaphylactic shock. Removal of natural rubber and latex-containing products from the operating room and avoidance of external and internal exposure of patients to latex antigen will prevent such allergic reactions. Updated guidelines for the safe management of latex allergy were published in 2009 by the Japanese Society of Latex Allergy. The previous guidelines regarding this topic were published in 2006. The new guidelines consist of 11 chapters that deal with background, exposure to latex antigen and development of sensitization, high-risk groups, natural rubber products, allergic reactions triggered by natural rubber products, diagnosis, latex-fruit syndrome, countermeasures and treatments in emergencies, prevention and safe management in the hospital, countermeasures in daily life, and limits for application of the guidelines. We had a case that required management according to the 2009 guidelines. A 49-year-old male doctor with a history of allergy to latex gloves was scheduled for laparoscopic cholecystectomy under general and epidural anesthesia for recurrent, acute cholecystitis. The anesthesia and operation were performed uneventfully with latex-free medical devices and machines in a latex-safe environment in the operating room under the new guidelines. Safe anesthetic management under the 2009 guidelines should be available for all operations in Japan on patients with latex allergy.

摘要

乳胶过敏是一种由免疫球蛋白E介导的针对天然乳胶抗原的反应。手术室设备通常包括由乳胶制成或含有乳胶的医疗装置,如手术手套、静脉输液管和导尿管等。这些产品可引发过敏反应,进而导致过敏性休克。从手术室移除天然橡胶和含乳胶产品,并避免患者内外接触乳胶抗原,可预防此类过敏反应。日本乳胶过敏学会于2009年发布了更新后的乳胶过敏安全管理指南。此前关于该主题的指南于2006年发布。新指南共11章,内容涉及背景、乳胶抗原暴露与致敏发展、高危人群、天然橡胶产品、天然橡胶产品引发的过敏反应、诊断、乳胶-水果综合征、紧急情况下的应对措施与治疗、医院内的预防与安全管理、日常生活中的应对措施以及指南的适用范围。我们有一个需依据2009年指南进行管理的病例。一名49岁有乳胶手套过敏史的男性医生因复发性急性胆囊炎计划在全身麻醉和硬膜外麻醉下行腹腔镜胆囊切除术。在新指南下,于手术室的乳胶安全环境中使用无乳胶医疗设备和机器,麻醉和手术顺利进行。在日本,对于有乳胶过敏的患者,所有手术都应采用2009年指南下的安全麻醉管理。

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