围手术期过敏反应

Overview of perioperative anaphylaxis

背景 随着各种药物特别是合成药物在围手术期的广泛应用，围手术期过敏反应的发生率逐渐增加。 目的 回顾围手术期过敏反应的病因、诊断、预防和治疗，以提高临床医师对这一危及生命事件的认识，降低其病死率。 内容 围手术期过敏反应是由患者在手术中暴露的一系列过敏原引起的，包括静脉麻醉剂（即丙泊酚）、NMBA、阿片类镇痛剂（吗啡、芬太尼、舒芬太尼、瑞芬太尼等）、局部麻醉剂、α-半乳糖苷酶和吸入麻醉剂。为预防过敏反应及鉴别过敏倾向，用药前应进行皮肤点刺试验或皮内试验，用药后应通过检测血浆中组胺、类胰蛋白酶和IgE水平，并计算血液中活化嗜碱性粒细胞的数量，以便于过敏反应的早期诊断。围手术期过敏反应的治疗包括肾上腺素抗休克，β2受体激动剂扩张支气管，糖皮质激素和抗组胺药物。 趋向 围手术期过敏反应的主要预防措施是避免接触常见的过敏原，对已发生的过敏反应，应早期诊断和治疗。此外，应确定过敏原以防止复发。

Background The incidence of perioperative anaphylaxis increases with the extensive use of various medications especially synthetic ones in perioperative period. Objective To review the etiology, diagnosis, prevention and treatment of perioperative anaphylaxis, in order to promote the awareness of this life-threatening event for clinicians to reduce its mortality rate. Content Perioperative anaphylaxis is caused by a series of allergens the patients are exposed to during operation, including intravenous anesthetics （i.e. propofol）, NMBA, opioid analgesics （morphine, fentanyl, sufentanyl, remifentanyl, etc）, local anesthetics, α-galactosidase, and inhaled anesthetics. To prevent the allergic reaction, identification of allergy propensity should be screened with skin prick test or intradermal test before the administration of above-mentioned drugs, and early diagnosis of allergic reaction after drug administration should be carried out by examining plasma levels of histamine, Tryptase and IgE, and counting the number of activated basophil cells in the blood. The treatment of perioperative anaphylaxis includes anti-shock with adrenalin, bronchodilation with β2 adrenoceptor agonists, glucocorticoid, and anti-histamine drugs. Trend The primary intervention for perioperative anaphylaxis is to avoid exposure to the most common allergens, if allergy appeared, early diagnosis and treatment should be carried out. Moreover, the allergens should be identified to prevent the reoccurrence.