心脏直视手术中鱼精蛋白过敏性休克的救治

Management of Anaphylactoid Shock to Protamine during Open- heart Surgery

回顾体外循环后鱼精蛋白拮抗肝素期间发生过敏性休克、心搏骤停2例，均属严重肺血管收缩型毒性反应。结合文献复习，作者认为：严重的鱼精蛋白过敏反应发病急骤，临床表现严重。立即二次转机辅助循环，应用副肾素、抗组织胺类药物和大剂量激素，及时补足血容量是主要抢救措施。而鱼精蛋白毒性反应发生与否与有无鱼类食物过敏史、注射途径、是否二次使用鱼精蛋白、鱼精蛋白皮试是否阴性均无相关性。缓慢注射（＞3min）可防止快速给药反应型毒性反应的发生，但无助于防止严重肺血管收缩型毒性反应的发生。

Two cases of anaphylactoid shock and cardiac arrest during protamine injection at the conclusion of cardiopulmonary bypass (CPB) were reviewed. They all belong to adverse catastrophic pulmonary vasoconstriction reaction to protamine. The authors suggest that serious anaphylactoid reaction to protamine happen rapidly and dangerously. The main management include circulation support by CPB, early and aggressive use of epinephrine, antihistamines and steroids, and rapid volume supplement. There are no relationship between adverse responseS of protamine and that Whether patients are allergic to fish, Whether protamine is injected intravenously or intraaortically,whether protamine is injected again and whether skin test is negative. Slow administration of protamine can prevent hypotension related to rapid administration (>3min), but can' t prevent catastrophic pulmonary vasoconstriction.