Kon N F, Masumo H, Nakajima S, Tozawa R, Kimura M, Maeda S
Department of Anaesthesiology, Gunma Cancer Center, Ota.
Masui. 1994 Oct;43(10):1606-10.
Biological tissue sealant is used for facilitation of intra-operative hemostasis. It is composed of cryoprecipitated fibrinogen, bovine-thrombin and bovine-aprotinin. In this report, we describe a 38-yr-old woman in whom severe anaphylactic shock occurred immediately after the topical use of biological tissue sealant on the completion of modified radical mastectomy. The patient's past history and pre-operative laboratory values were unremarkable except for mild nasal allergy. Postoperative prick tests for bovine-serum, bovine-thrombin and bovine-aprotinin were positive. Total IgE level was normal. By the radioallergosolbent tests (RAST), specific IgE antibodies for aprotinin were elevated to the class 2 level. Drug induced lymphocyte stimulation tests (DLST) were negative. These indicated that the case was an aprotinin-induced anaphylaxis during general anaesthesia. The level of CH50, C4, C1q and C5 decreased in the serum sample immediately after the shock, but C3 was unchanged. It was considered to be a direct degradation of the complement by the proteolytic enzymes. Biological tissue sealant should be used cautiously bearing in mind the possibility of anaphylactic complication.
生物组织密封剂用于促进术中止血。它由冷沉淀纤维蛋白原、牛凝血酶和牛抑肽酶组成。在本报告中，我们描述了一名38岁女性，在改良根治性乳房切除术后局部使用生物组织密封剂后立即发生严重过敏性休克。除轻度鼻过敏外，患者既往史和术前实验室检查结果均无异常。术后对牛血清、牛凝血酶和牛抑肽酶的点刺试验呈阳性。总IgE水平正常。通过放射变应原吸附试验（RAST），抑肽酶特异性IgE抗体升高至2级。药物诱导淋巴细胞刺激试验（DLST）为阴性。这些表明该病例是全身麻醉期间由抑肽酶引起的过敏反应。休克后立即采集的血清样本中CH50、C4、C1q和C5水平降低，但C3未改变。这被认为是蛋白水解酶对补体的直接降解。考虑到过敏并发症的可能性，应谨慎使用生物组织密封剂。
