苯磺顺阿曲库铵致过敏性休克

Anaphylactic shock induced by cisatracurium besilate

1例68岁男性患者因颈椎病、椎间盘突出、椎管狭窄、脊髓压迫症、颈髓损伤行手术治疗。手术开始后静脉注射地塞米松10 mg、苯磺顺阿曲库铵2 mg和血凝酶2 U。5 min后患者血压降至50/40 mm Hg(1 mm Hg=0.133 kPa),心率130次/min,脉搏血氧饱和度0.90,四肢及躯干出现红色皮疹。立即给予肾上腺素、甲泼尼龙、去氧肾上腺素等,同时放弃手术,缝合手术切口。10 min后患者血压升至110/65 mm Hg,生命体征渐趋稳定。3 d后再次手术,手术开始后5 h静脉注射苯磺顺阿曲库铵5 mg,5 min后患者再次出现血压下降(55/40 mm Hg),四肢及躯干出现红色皮疹。给予肾上腺素及甲泼尼龙素等抢救,20 min后血压恢复至105～115/65～70 mm Hg,1 h后手术顺利完成。

A 68-year-old man undetwefit operation for cervical spondylopathy, herniated disk, spinal canal stenosis, compressive myelopathy, and cervical spinal cord injury. After the start of the operation, dexamethasone 10 mg, cisatracurium besilate 2 rag, and hemocoagulase 2 U were given intravenously. Five minutes later, the patient＇s blood pressure fell to 50/40 mm Hg, his heart rate was 130 beats/min and oxygen saturation was 0.90. He developed red rashes on his limbs and trunk. Phenylephrine, methylprednisolone, and diphenhydramine were given immediately. Meanwhile the operation was given up and surgical incision was sutured. Ten minutes later, his blood pressure rose to 110/65 mm Hg and vital signs became more stable. Three days later, he underwent operation again and, five hours after the start of the operation, he received IV cisatracurium besilate 5 rag. Five minutes later, the patient＇s blood pressure fell again （55/40 mm Hg ） and red rashes appeared on his limbs and trunk. Phenylephrine, methylprednisolone, and other resuscitative measures were administered. Twenty minutes later, his blood pressure returned to 105-115/65-70 mm Hg and, one hour later, his surgery was completed uneventfully.