Murakami Yu, Kaneko Shohei, Yokoyama Haruka, Ishizaki Hironori, Sekino Motohiro, Murata Hiroaki, Hara Tetsuya
Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
JA Clin Rep. 2021 Dec 15;7(1):86. doi: 10.1186/s40981-021-00490-4.
The efficacy of glucagon for adrenaline-resistant anaphylactic shock in patients taking β-blockers is controversial. However, understanding the efficacy of glucagon is important because adrenaline-resistant anaphylactic shock is fatal. We present a case of severe adrenaline-resistant anaphylactic shock in a patient taking a β-blocker, and glucagon was effective in improving hemodynamics.
An 88-year-old woman with severe aortic stenosis and taking a selective β-1 blocker underwent transcatheter aortic valve implantation under general anesthesia. Postoperatively, she received 100 mg sugammadex, but 2 min later developed severe hypotension and bronchospasm. Suspecting anaphylactic shock, we intervened by administering adrenaline, fluid loading, and an increased noradrenaline dose. Consequently, the bronchospasm improved, but her blood pressure only increased minimally. Therefore, we administered 1 mg glucagon intravenously, and the hypotension resolved immediately.
Glucagon may improve hemodynamics in adrenaline-resistant anaphylactic shock patients taking β-blockers; however, its efficacy must be further evaluated in more cases.
胰高血糖素对服用β受体阻滞剂患者的肾上腺素抵抗性过敏性休克的疗效存在争议。然而，了解胰高血糖素的疗效很重要，因为肾上腺素抵抗性过敏性休克是致命的。我们报告一例服用β受体阻滞剂患者发生严重肾上腺素抵抗性过敏性休克的病例，胰高血糖素有效改善了血流动力学。
一名88岁患有严重主动脉瓣狭窄且正在服用选择性β-1受体阻滞剂的女性在全身麻醉下接受了经导管主动脉瓣植入术。术后，她接受了100毫克舒更葡糖，但2分钟后出现严重低血压和支气管痉挛。怀疑是过敏性休克，我们通过给予肾上腺素、补液和增加去甲肾上腺素剂量进行干预。结果，支气管痉挛有所改善，但她的血压仅略有升高。因此，我们静脉注射了1毫克胰高血糖素，低血压立即得到缓解。
胰高血糖素可能改善服用β受体阻滞剂的肾上腺素抵抗性过敏性休克患者的血流动力学；然而，其疗效必须在更多病例中进一步评估。
