191例利多卡因致过敏性休克文献分析

Literature analysis of 191 cases of anaphylactic shock induced by lidocaine

目的探讨利多卡因致过敏性休克的临床特征,为临床安全用药提供参考。方法回顾分析我院2016年10月1日至2019年12月31日3例利多卡因致过敏性休克的病例,同时检索Pubmed、Sciencedirect、中国知网、万方数据和维普网,汇总分析国内外报道的不良反应文献。结果共191例病例纳入分析,病例中位年龄35岁,男女人数比例1:1.15。57例(29.8%)曾有药物过敏史。155例(81.2%)在用药后10 min内发生过敏性休克。164例恢复(85.9%),27例(14.1%)死亡。过敏性休克发生时间t≤5 min组与5 min<t≤10 min组之间死亡率差异有统计学意义,表面麻醉组和局部浸润组之间死亡率差异有统计学意义(Bonferroni校正,P<0.0125)。结论利多卡因致过敏性休克的致死率与局麻药过敏史、给药剂量和麻醉方式可能有关,临床应用前应详细询问患者药物过敏史,依照合适的剂量和速度给药,用药全程加强监护。

Objective To study the characteristics and regularity of anaphylactic shock induced by lidocaine and provide reference for clinical application.Methods Three cases of anaphylactic shock developed after administration of lidocaine between October 1,2016 and December 31,2019 in the National Cancer Center were analyzed.Literature related to anaphylactic shock that was published as of December 2019 was retrieved from such databases as Pubmed,CNKI and Wanfang.Results A total of 191 cases were collected.The median age was 35 years old and the ratio of males to females was 1∶1.15.Among these cases,57(29.8%)had a history of allergy,155(81.2%)developed anaphylactic shock within 10 minutes of lidocaine use,164(85.9%)recovered and 27 cases(14.1%)died.The mortality rate,which varied according to the onset time of shock,was statistically different not only between the group with an onset time≤5 min and the group with an onset time of 5 min<t≤10 min,but also between the group under topical anesthesia and the group with local infiltration.Conclusion The occurrence and fatality of anaphylactic shock induced by lidocaine may be related to the allergy history of local anesthetics,dosage and ways of anesthesia.Clinicians should inquire about the allergy history in detail,choose proper dosage and speed of administration and monitor patients in the whole course of lidocaine use.