摘要
手术过程中,患者与麻醉药物、抗生素、血液制品、肝素、多肽(如抑肽酶、乳胶、鱼精蛋白)以及血容量扩充剂等多种外源性物质相接触,这些药物可能引发致命的“过敏”性变态反应。围手术期过敏反应主要表现为急性心肺功能障碍。心脏手术的患者由于有全面的监测,过敏反应一旦发生,能够被快速识别并加以治疗。由于使用治疗剂量之前,先给予患者小剂量药物(常称为试验量)即可能引发过敏反应,因此,临床医生必须随时准备应对可能发生的过敏反应。对于血流动力学不稳定的患者,建立心肺转流不失为一种拯救生命的策略,尤其适用于顽固性心血管功能失代偿的患者。对于血管扩张性休克者,还应考虑使用精氨酸加压素。本篇综述着重围绕心脏手术患者,针对手术室内具有过敏危险的患者,探讨过敏发生率和过敏处理措施的新理念。
During surgery, patients are exposed to multiple foreign substances including anesthetic drugs, antibiotics, blood products, heparin, polypeptides ( aprotinin, latex, and protamine), and intravascular volume expanders, which have the potential to produce life-threatening allergic reactions termed "anaphylaxis." The hallmark of perioperative anaphylaxis is acute cardiovascular and pulmonary dysfunction. Patients undergoing cardiac surgery have extensive monitoring that permits rapid recognition and treatment when anaphylaxis occurs. Initial, smaller doses of drugs, often called test doses, administered before the therapeutic dose may produce anaphylaxis, and so clinicians need to be prepared to treat reactions if they occur. Institution of cardiopulmonary bypass for hemodynamically unstable patients can be a life-saving maneuver, and should be considered in patients with refractory cardiovascular dysfunction. Arginine vasopressin should also be considered for patients with vasodilatory shock. In this review, we focus on recent concepts in understanding the incidence and management approaches for patients at risk for anaphylaxis in the operating room setting, with an emphasis on cardiac surgical patients.
出处
《麻醉与镇痛》
2009年第2期18-30,共13页
Anesthesia & Analgesia