Mertes Paul Michel, De Blay Frédéric, Dong Siwei
CHU de Nancy, hôpital Central, service d'anesthésie-réanimation chirurgicale, 54035 Nancy cedex, France.
Presse Med. 2013 Mar;42(3):269-79. doi: 10.1016/j.lpm.2012.04.026. Epub 2012 Jul 6.
Anaphylactic reactions may be either of immune(allergy, usually IgE-mediated, sometimes IgG-mediated) or non-immune origin. The incidence of anaphylactic reactions during anaesthesia varies between countries ranging from 1/1250 to 1/13,000 per procedure. In France, the estimated incidence of allergic reactions is 100.6 [76.2-125.3]/million procedures with a high female predominance (male: 55.4 [42.0-69.0], female: 154.9 [117.2-193.1]). This predominance is not observed in children. In adults, the most frequently incriminated substances are neuromuscular blocking agents, followed by latex and antibiotics. The estimated incidence of allergic reactions to neuromuscular blocking agents is 184.0 [139.3-229.7]/million procedure. In most cases there is a close reaction between clinical symptoms and drug administration. When the reaction is delayed, occurring during the surgical procedure, a reaction involving latex, a vital dye, an antiseptic or a volume expanding fluid should be suspected. Reaction severity may vary. The most frequently reported initial symptoms are pulselessness, erythema, increased airway pressure, desaturation or decreased end-tidal CO2. Clinical symptoms may occur as an isolated condition, making proper diagnosis difficult. In some cases a cardiovascular arrest can be observed. Reaction mechanism identification relies on mediators (tryptase, histamine) measurement at the time of the reaction. In case of allergic reaction, the responsible drug can be identified by the detection of specific IgE using immunoassays or by skin tests performed 6 weeks after the reaction. Predictive allergy investigation to latex or anaesthetics in the absence of history of reaction should be restricted to at-risk patients. Premedication cannot prevent the onset of an allergic reaction. Providing a latex-free environment can be used for primary or secondary prevention. Treatment is based on allergen administration interruption, epinephrine administration in a titrated manner based on symptoms severity, and on volume expansion.
过敏反应可能源于免疫性（过敏，通常由IgE介导，有时由IgG介导）或非免疫性。麻醉期间过敏反应的发生率在不同国家有所差异，每次手术的发生率在1/1250至1/13000之间。在法国，估计过敏反应的发生率为每百万次手术100.6[76.2 - 125.3]例，女性占比很高（男性：55.4[42.0 - 69.0]，女性：154.9[117.2 - 193.1]）。这种性别差异在儿童中未观察到。在成人中，最常引发过敏反应的物质是神经肌肉阻滞剂，其次是乳胶和抗生素。估计对神经肌肉阻滞剂过敏反应的发生率为每百万次手术184.0[139.3 - 229.7]例。在大多数情况下，临床症状与药物给药之间存在密切关联。当反应延迟发生在手术过程中时，应怀疑是由乳胶、活性染料、防腐剂或扩容液引起的反应。反应严重程度可能不同。最常报告的初始症状有无脉、红斑、气道压力增加、血氧饱和度降低或呼气末二氧化碳减少。临床症状可能单独出现，这使得正确诊断变得困难。在某些情况下，可观察到心血管骤停。反应机制的确定依赖于反应时介质（类胰蛋白酶、组胺）的测量。对于过敏反应，可通过免疫测定检测特异性IgE或在反应6周后进行皮肤试验来确定致敏药物。在没有反应史的情况下，对乳胶或麻醉剂进行预测性过敏调查应仅限于高危患者。术前用药不能预防过敏反应的发生。提供无乳胶环境可用于一级或二级预防。治疗基于中断过敏原给药、根据症状严重程度滴定使用肾上腺素以及扩容。
