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[罗库溴铵麻醉诱导过敏性休克:一例报告]

[Rocuronium anesthesia induced anaphylactic shock: a case report].

作者信息

Qiu Min, Zong Ya-nan, Lu Jian, Ma Lu-lin, Zheng Qing, Guo Xiang-yang

机构信息

Department of Urology, Peking University Third Hospital, Beijing 100191, China.

Department of Anesthesiology,Peking University Third Hospital, Beijing 100191, China.

出版信息

Beijing Da Xue Xue Bao Yi Xue Ban. 2015 Oct 18;47(5):885-7.

Abstract

Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen, and it could be an unpredictable and life-threatening cause during anesthesia. The main purpose of this paper is to report a case of anaphylactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period. A 63-year-old man, with a mass on his adrenal, was scheduled to a laparoscopic adrenal tumor excision. During the anesthesia induction period, after administrated sulfentanil, propofol and rocuronium, the blood pressure was decreased and the heart rate was increased. Then, the patient had rash on his whole body and developed an anaphylactic shock. After being treated with the anti-allergic agents and norepinephrine, the rash disappeared and the vital sign become stable. The patient felt nothing uncomfortable during the two weeks'follow-up. Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period. The most common inducements are muscle relaxant, latex and antibiotics. Anaphylactic reactions in the perioperative period are often serious and potentially life-threatening conditions, involving multiple organ systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils. Before anesthesia, we should acquire the allergic history. During the anesthesia period, the vital sign and the skin should be observed carefully.

摘要

过敏反应是对过敏原的一种急性致命性全身过敏反应,在麻醉期间它可能是一个不可预测且危及生命的原因。本文的主要目的是报告一例麻醉诱导期间发生过敏性休克的病例,并回顾麻醉期间过敏反应和类过敏反应的预防及治疗。一名63岁男性,肾上腺有肿物,计划行腹腔镜肾上腺肿瘤切除术。在麻醉诱导期,给予舒芬太尼、丙泊酚和罗库溴铵后,血压下降,心率加快。随后,患者全身出现皮疹并发生过敏性休克。经抗过敏药物和去甲肾上腺素治疗后,皮疹消退,生命体征稳定。在两周的随访期间,患者无任何不适。过敏反应和类过敏反应在麻醉期间并不罕见。最常见的诱因是肌肉松弛剂、乳胶和抗生素。围手术期的过敏反应通常是严重且可能危及生命的情况,涉及多个器官系统,其临床表现是肥大细胞和嗜碱性粒细胞释放预先形成的介质的结果。麻醉前,我们应了解过敏史。在麻醉期间,应仔细观察生命体征和皮肤情况。

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