苯磺顺阿曲库铵致过敏性休克

Anaphylactic shock associated with cisatracurium besilate

1例女性58岁患者因第12胸椎压缩性骨折,拟于全身麻醉下行后路闭合复位椎弓根针内固定联合经椎弓根体内椎骨融合术.术前先给予舒芬太尼、依托咪酯、苯磺顺阿曲库铵诱导麻醉,麻醉维持使用了瑞芬太尼、丙泊酚、七氟醚.诱导麻醉15 min后患者出现低血压及双上肢皮肤发红,未引起注意.继续追加氟比洛芬酯注射液、地佐辛、舒芬太尼和苯磺顺阿曲库铵,患者血压突然迅速降至51/28 mmHg,全身出现红疹.立即给予肾上腺素、甲泼尼龙、阿托品等抗过敏、抗休克治疗,多巴胺静脉泵入维持血压.1h后患者血压平稳.1.5h后因患者出现呛咳、体动,第3次给予苯磺顺阿曲库铵6 mg,血压再次下降（85/50 mmHg）,全身皮疹加重.考虑为苯磺顺阿曲库铵致过敏性休克.继续给予抗休克治疗.第2天,患者生命体征平稳,皮疹消退.

A 58-year-old female patient with compression fracture of the 12th thoracic vertebra intended to undergo closed reduction and pedicle screw fixation and transvertebral fusion of the posterior approach under general anesthesia. Before the operation,sufentanil,etomidate,and cisatracurium besilate were given for anesthetic induction,remifentanil,propofol,and sevoflurane for anesthetic maintenance. Fifteen minutes after anesthetic induction,hypotension and reddish skin on upper limbs appeared,but were neglected. Flurbiprofen,dezocine,and cisatracurium besilate were added and the patient′s blood pressure sharply declined to 51/28 mmHg,accompanied by rashes on her whole body. An immediate injection of adrenaline,methyl prednisolone,atropine and intravenous pumping of dopamine were given. One hour later, the blood pressure was stable. One and a half hours later,choking,coughing,and body movement appeared,the third injection of cisatracurium besilate 6 mg was given. Then the patient′s blood pressure decreased again（85/50 mmHg）and rashes aggravated. It was considered that the patient developed cisatracurium besilate induced anaphylactic shock. Anti-shock treatments were given continuously. The next day,the patient′s life signs were stable and rashes subsided.