围麻醉期过敏反应发生率及危险因素分析:一项2012—2017年回顾性调查

Prevalance of peri-anesthesia allergy and its related risk factor: a retrospective survey from 2012-2017

目的:通过回顾性研究调查一所三级甲等医院的围麻醉期过敏反应发生率。方法:本研究为回顾性队列研究,选择2012年1月至2017年4月期间在北京大学第一医院手术室内接受手术的患者作为研究对象。通过电子病历系统筛选发生过敏反应的患者,根据我国《围术期过敏反应诊治的专家共识》及《Scandinavian围麻醉期过敏反应诊断和处理指南》中的定义确认患者是否发生了过敏反应并进行分级,先通过电子病历数据系统获得所有患者的数据,由两位研究者分别独立进行数据初步筛选和补充数据,然后交叉核对数据,最后由另外两位研究者审核数据并与电子病历系统进行比对。采集患者术前资料、手术方式、麻醉方式、围麻醉期药物种类和预后等数据,通过单因素分析筛选与过敏反应可能相关的因素,将单因素分析中有统计学意义(P<0.05)的变量带入多因素回归分析,通过多因素回归分析导致围麻醉期过敏反应的危险因素。结果:106 074例患者符合入选和排除标准,过敏反应的总发生率约为1.5/1 000(156/10 6074),其中Ⅰ级过敏反应占64.1%(100/156),Ⅱ级过敏反应占30.1%(47/156),Ⅲ级过敏反应占5.8%(9/156),未出现Ⅳ级和Ⅴ级过敏反应的病例。多因素Logistic回归分析显示既往过敏史(OR=6.836,95%CI:4.461~10.474,P<0.001)、术中使用舒芬太尼(OR=1.993,95%CI:1.228~3.232,P=0.005)、术中使用顺式阿曲库铵(OR=2.495,95%CI:1.599~3.893,P<0.001)、术中输注抗生素(OR=2.005,95%CI:1.375~2.924,P<0.001)和术中输注异体血浆(OR=3.055,95%CI:1.842~5.068,P<0.001)是围术期过敏反应的危险因素。结论:围麻醉期过敏反应的发生率较高,尚需要建立围麻醉期药物过敏诊断和治疗的标准化流程。

Objective ： To investigate the incidence of peri-anesthesia allergy in a tertiary teaching hos-pital. Methods ： This was a retrospective cohort study. Patients who received anesthesia in operation rooms at Peking University First Hospital from January 2012 to April 2017 were enrolled. Researchers re-viewed all the patients ^ electronic records and screened suspect allergy cases. Allergy was diagnosed ac-cording to the definition in Consensus on Management of Perioperative Allergy （China） and Scandinavian Clinical Practice Guidelines on the Diagnosis, Management and Follow-up of Anaphylaxis during Anesthe-sia. After obtaining the electronic records, two researchers began to screen and supplement mis-sing data according medical records independently, then they checked out each other ’s data. The final data were reviewed by another two researchers. We collected the patients’ basic characteristics, surgery type, anes-thesia type, peri-anesthesia use of drugs, prognosis and other data. Univariate logistic regression was em-ployed to screen potential factors of allergy. Factors with statistical significance （P 〈0.05） in univariate Logistic regression were entered into multivariate Logistic regression to identify independent risk factors of allergy. Results： In the study, 106 074 patients entered final statistic analysis. The incidence of peri- anesthesia allergy was about 1.5/1 000 （156/106 074）. The incidence of Grades I , II and IH allergy was 64.1% （100/156） , 30. 1% （47/156）, and 5. 8% （9/156） respectively. Multivariate logistic re-gression showed 5 independent risk factors of allergy including history of allergy （OR =6. 836, 95% C l：4.461 -10.474, P〈0.001）, intraoperative use of sufentanil （OR =1.993, 95% CI： 1.228 -3.232,P =0. 005） , intraoperative use of cis-atracuronium （ OR = 2. 495, 95% Cl： 1. 599 - 3.893, P 〈 0.001）, intraoperative infusion of antibiotics （OR=2.005, 95% CI ： 1.375 -2.924, P〈0.001） andfrozen fresh plasma （ OR =3.055, 9 5 % CI： 1.842 - 5.068 , P 〈 0. 001）. C o n c lu s io n ; The incidence of peri-anesthesia al lergy is high and fu r th er attempt is needed to establish standard operation process o f d i-agnosis and treatment of al lergy.