围手术期过敏反应的发生率：一项单中心、前瞻性队列研究。

The incidence of perioperative hypersensitivity reactions: a single-center, prospective, cohort study.

作者信息

Berroa Felicia, Lafuente Alberto, Javaloyes Gracia, Cabrera-Freitag Paula, de la Borbolla Juan M, Moncada Rafael, Goikoetxea Maria J, Sanz Maria L, Ferrer Marta, Gastaminza Gabriel

机构信息

From the Departments of Allergy and Anaesthesiology, Clínica Universidad de Navarra, Pamplona, Spain.

出版信息

Anesth Analg. 2015 Jul;121(1):117-123. doi: 10.1213/ANE.0000000000000776.

DOI:10.1213/ANE.0000000000000776

PMID:25902325

Abstract

BACKGROUND

The incidence of perioperative hypersensitivity reactions, which can be life-threatening, ranges from 1 in 20,000 to 1 in 1361. These reactions are usually classified as IgE or non-IgE mediated. The aim of this study was to determine the incidence of allergic reactions during general anesthesia in our hospital, to establish the incidence of the allergic reactions for each drug used, to assess the frequency of IgE-mediated reactions in even mild reactions, and to compare the degree of agreement between anesthesiologist suspicion and allergy diagnosis.

METHODS

We included patients diagnosed with a clinical hypersensitivity reaction during a procedure under general anesthesia over a 30-month period (February 2008 to August 2010). Plasma histamine and serum tryptase concentrations were determined in these patients. We performed skin tests to diagnose the causative agent. Data from the hospital electronic prescribing system were collected to determine the ratio of reactions for each drug.

RESULTS

During the study period, 16,946 anesthetic procedures were performed (53% involved males; mean age, 51.6 years). Forty-four perianesthetic reactions were recorded, and the ratio of reactions was 1 in 385 operations (95% confidence interval, 1/529-1/287). Twenty-five reactions (25/44; 57%) occurred during the induction of anesthesia. Twenty-one reactions (21/44; 48%) were mild, involving only skin, and 23 of 44 (52%) were anaphylactic reactions. Four of 10 patients who had only a rash experienced IgE-mediated reactions. Five surgeries (11%) were suspended because of the severity of the reactions. Fifteen reactions (15/30; 50%) were IgE mediated, and, in 2 of 30 (7%), a non-IgE agent was found (cold urticaria and nonsteroidal anti-inflammatory drug intolerance). The ratio of reactions for each drug was as follows: protamine, 1 in 468; cisatracurium, 1 in 1388; amoxicillin-clavulanate, 1 in 1968; atracurium, 1 in 2039; and dipyrone, 1 in 3159.

CONCLUSIONS

Perioperative reactions are more common than previously reported. Mild hypersensitivity perioperative reactions-involving only skin-should be considered in evaluating patients because a substantial number of these reactions are IgE mediated.

摘要

背景

围手术期过敏反应可危及生命，其发生率在20000分之一至1361分之一之间。这些反应通常分为IgE介导或非IgE介导。本研究的目的是确定我院全身麻醉期间过敏反应的发生率，确定每种使用药物的过敏反应发生率，评估即使是轻度反应中IgE介导反应的频率，并比较麻醉医生怀疑与过敏诊断之间的一致程度。

方法

我们纳入了在30个月期间（2008年2月至2010年8月）接受全身麻醉手术时被诊断为临床过敏反应的患者。测定这些患者的血浆组胺和血清类胰蛋白酶浓度。我们进行皮肤试验以诊断病因。收集医院电子处方系统的数据以确定每种药物的反应比例。

结果

在研究期间，共进行了16946例麻醉手术（53%为男性；平均年龄51.6岁）。记录到44例围麻醉期反应，反应比例为385例手术中有1例（95%置信区间，1/529 - 1/287）。25例反应（25/44；57%）发生在麻醉诱导期。21例反应（21/44；48%）为轻度，仅累及皮肤，44例中有23例（52%）为过敏反应。10例仅有皮疹的患者中有4例发生了IgE介导的反应。5例手术（11%）因反应严重而中止。15例反应（15/30；50%）为IgE介导，30例中有2例（7%）发现非IgE介质（冷性荨麻疹和非甾体抗炎药不耐受）。每种药物的反应比例如下：鱼精蛋白，468例中有1例；顺式阿曲库铵，1388例中有1例；阿莫西林 - 克拉维酸，1968例中有1例；阿曲库铵，2039例中有1例；安乃近，3159例中有1例。