气道压力在判断体外循环鱼精蛋白过敏反应中的价值

Clinical value of airway pressure in prediction of allergic reaction after protamine administration during cardiopulmonary bypass surgery

目的分析气道压力增高在判断体外循环手术中鱼精蛋白过敏反应中的价值。方法择期手术的先天性心脏病患儿402例，静吸复合全身麻醉，体外循环结束后，经静脉推注1．5倍肝素剂量鱼精蛋白，输注速度为每分钟1mg／kg，每隔1分钟记录气道压力（Paw），同时监测心率（HR）、血压（BP）、指脉搏血氧饱和度（SpO2）、中心静脉压（CVP）、肺动脉压（PAP）和呼气末二氧化碳分压（PETCO2）。平均动脉压（MBP）下降≥10mmHg确定为鱼精蛋白毒性反应，下降〈30mmHg为轻度反应，〉130mmHg为中重度反应，分析Paw增高与鱼精蛋白过敏反应的关系，并判断其敏感性。结果发生鱼精蛋白反应21例，发生率为5．2％，其中5例为轻度反应，仅表现为血压下降；16例为严重过敏反应，Paw均升高且明显早于血压下降，提前（42．4±19．4）秒，灵敏性仅次于PAP增高，差异有显著性意义（P〈0．05）。结论在鱼精蛋白中和过程中，气道压力增高能早期提示鱼精蛋白中、重度过敏反应。

Objective To evaluate the role of the airway pressure in prediction of allergic reac- tion after protamine administration during cardiopulmonary bypass surgery. Methods A total of 402 chil- dren withcongenital heart diseasesundergoing selective cardiac surgery were enrolled. A combined general anesthesia was induced via intravenous injection andinhalation. Protamine was intravenously infused at the rate of 1 mg/kg/min. Airway pressure （Paw） , heart rate, blood pressure, pulse oxygen saturation, central venous pressure, pulmonary artery pressure, partialpressureofend-trialcarbon dioxidewere assessed every minute aftercardiopulmonary bypassing. Toxic reaction of protamine [ MBP（ mean blood pressure）decline ≥ 10 mmHg] were classified as mild reaction（ MBP decline 〈 30 mmHg）and severe reaction（ MBP decline ≥30 mmHg）. The relationship between Paw elevation and allergic reactionand related sensibilitywere ana- lyzed. Results A total of 21 （5.2%）patientshad allergic reaction, including 5 mild cases and 16 severe cases. Before the drop of blood pressure, Paw obviously increased （42.4 ± 19.4 ） secondsin advance. The sensibility of Paw was second to the PAP elevation （ P 〈 0.05 ）. Conclusion During theneutralization of protamine, the increased Paw can predict severe allergicreaction of protamine at an early stage.