围手术期严重过敏反应病因诊断结果

Etiology of anaphylaxis during general anaesthesia: analysis of 23 cases

目的初步探讨我国围手术期严重过敏反应的病因。方法总结分析于2016年8月至2020年4月,因可疑发生围手术期严重过敏反应,在四川大学华西医院过敏性疾病诊治中心进行病因诊断的23例患者的临床资料。结果18例(78.3%)患者经检测明确了致敏药物,包括神经肌肉松弛剂(neuromuscular blocking agent,NMBA)11例(61.1%),氯己定4例(22.2%),镇静催眠药3例(16.7%),抗生素1例(5.6%),琥珀酰明胶1例(5.6%)。3例(13.0%)患者尽管对所有可疑药物进行了检测,但未能明确致敏原。2例患者(8.7%)临床病史提示非过敏反应,但仍进行了全面检测以除外过敏反应的可能。结论本研究初步提示在中国,NMBAs和氯己定可能是引起围手术期严重过敏反应最常见的致敏药物。

Objective To investigate the causative agents of anaphylaxis during general anaesthesia preliminarily in China.Methods The clinical data of 23 patients with suspected perioperative anaphylaxis were analyzed,who were admitted to Allergy Center of West China Hospital,Sichuan University since August 2016 to April 2020.Results The culprit drugs were identified among 18 patients(78.3%),which were neuromuscular blocking agent(NMBA)(n=11,61.1%),chlorhexidine(n=4,22.2%),sedative-hypnotic drug(n=3,16.7%),antibiotic(n=1,5.6%),and gelofusine(n=1,5.6%).None of causative agent was identified in 3 patients(13.0%),despite full investagations.Clinical history suggested non-anaphylactic reaction in another two patients(8.7%),but full investigations were performed to eliminate the possibility of allergic causation.Conclusion NMBAs and chlorhexidine may be the top two common causative agents of perioperative anaphylaxis in China.