Olinger G N, Becker R M, Bonchek L I
Ann Thorac Surg. 1980 Jan;29(1):20-5. doi: 10.1016/s0003-4975(10)61620-7.
Four instances of severe anaphylactoid reaction occurring subsequent to cardiopulmonary bypass are described. These catastrophic reactions, from which 2 patients died, took place approximately an hour following administration of protamine and were characterized by marked peripheral vasodilatation, loss of capillary membrane integrity, and fulminant noncardiogenic pulmonary edema. Primary cardiac depression was not evident. We hypothesize that protamine was the causative agent in these unusually severe reactions. Differential diagnosis from other causes of acute cardiorespiratory dysfunction depended on early assessment of pulmonary artery and left ventricular filling pressures, cardiac output, respiratory mechanics, and arterial blood gases. Therapy was difficult; success in 1 of the patients seemed to have been effected in part by prompt administration of high-dose corticosteroids and maintenance of peripheral vascular tone with an alpha-adrenergic agonist.
本文描述了4例在体外循环后发生严重类过敏反应的病例。这些灾难性反应导致2例患者死亡，发生在注射鱼精蛋白后约1小时，其特征为明显的外周血管扩张、毛细血管膜完整性丧失和暴发性非心源性肺水肿。未发现原发性心脏抑制。我们推测鱼精蛋白是这些异常严重反应的致病因素。与其他急性心肺功能障碍原因的鉴别诊断取决于对肺动脉和左心室充盈压、心输出量、呼吸力学和动脉血气的早期评估。治疗困难；其中1例患者的成功似乎部分得益于及时给予大剂量皮质类固醇以及使用α-肾上腺素能激动剂维持外周血管张力。
