Vaquerizo A, Sola J L, Bondía A, Opla J M, Madariaga M J
Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza.
Rev Esp Anestesiol Reanim. 1994 Mar-Apr;41(2):113-6.
Certain parts of Spain continue to have a high incidence of hydatid disease. Anaphylaxis mediated by IgE, due to the high concentration of antigens in the blood stream, is a serious but fortunately infrequent complication of surgery. We present two cases of anaphylactoid reaction in patients undergoing surgery for excision of hydatid cysts and one case of a patient scheduled for cholecystectomy with unsuspected hydatid disease. This represents three cases presenting vascular collapse accompanied by metabolic acidosis, from among a total of 53 surgical patients handled by our department between January 1992 and May 1993. Early, essentially clinical, diagnosis and immediate start of treatment with adrenaline, suspension of inhaled anesthetics, administration of 100% oxygen, and restoration of intravascular volume with colloids or crystalloids were decisive in assuring the favorable outcome for these patients. Hydatid disease must be considered as a differential diagnosis in cases of shock during surgery in areas where it is endemic. Although infrequent, the possibility of anaphylaxis must be kept in mind whenever there is sudden hemodynamic deterioration during surgery for removal of a hydatid cyst. Early diagnosis and appropriate treatment are essential for a favorable outcome.
西班牙的某些地区包虫病发病率仍然很高。由于血流中抗原浓度高，由IgE介导的过敏反应是手术中一种严重但幸运的是不常见的并发症。我们报告了两例在接受包虫囊肿切除手术的患者中发生类过敏反应的病例，以及一例计划进行胆囊切除术但未被怀疑患有包虫病的患者。在1992年1月至1993年5月期间，我们科室共处理了53例外科手术患者，这三例患者均出现血管性虚脱并伴有代谢性酸中毒。早期主要通过临床诊断，并立即开始用肾上腺素治疗、停用吸入麻醉剂、给予100%氧气以及用胶体或晶体液恢复血管内容量，这些措施对于确保这些患者获得良好预后起了决定性作用。在包虫病流行地区，手术中出现休克的病例必须将包虫病作为鉴别诊断之一。尽管罕见，但在切除包虫囊肿的手术过程中，一旦出现突然的血流动力学恶化，必须考虑过敏反应的可能性。早期诊断和适当治疗对于取得良好预后至关重要。
