术中严重过敏反应的危险因素分析

Analysis of risk factors for intraoperative severe anaphylaxis

目的分析术中发生严重过敏反应的危险因素。方法选择2014年1月至2019年12月手术患者375例,符合《斯堪的纳维亚围麻醉期过敏反应诊断和处理指南》Ⅱ—Ⅴ级过敏反应为过敏组(n=75),采用巢式病例-对照研究进行匹配,选择未发生过敏反应的手术患者为对照组(n=300)。分析患者的一般资料、手术方式、麻醉方式、手术类型(腹部手术、骨科手术、神经外科手术、耳鼻喉手术、心胸外科手术)、围麻醉期药物种类及治疗情况等,将单因素Logistic分析中P<0.1的因素纳入多因素Logistic回归分析术中发生严重过敏反应的独立危险因素。结果手术患者共有202857例,发生术中严重过敏反应的有77例(3.8/10000),其中发生Ⅱ、Ⅲ、Ⅳ级过敏反应的分别有41例(54.7%)、32例(42.7%)、2例(2.6%)。多因素Logistic分析显示既往过敏史(OR=3.136,95%CI 1.027~9.579,P=0.045)、术中应用顺式阿曲库铵(OR=5.248,95%CI 1.481~18.589,P=0.010)、术中输注羟乙基淀粉130/0.4(OR=8.418,95%CI 3.779~18.752,P<0.001)、术中输注异体血浆(OR=6.100,95%CI 2.363~15.745,P<0.001)为术中严重过敏反应的独立危险因素。结论既往过敏史、术中使用顺式阿曲库铵、术中输注羟乙基淀粉130/0.4、术中输注异体血浆为术中发生严重过敏反应的独立危险因素。

Objective To identify the risk factors of intraoperative severe anaphylaxis.Methods A total of 375 patients who underwent surgery from January 2014 to December 2019 were selected.According to the Scandinavian Clinical Practice Guidelines on the Diagnosis,Management and Follow-up of Anaphylaxis during Anesthesia,gradeⅡ-Ⅴanaphylaxis were selected as the allergic group(n=75).Using the design method of the Nested case-control study,the patients who did not have an anaphylaxis were selected as the control group(n=300).The general characteristics,methods of surgery,anesthesia methods,types of surgery(abdominal surgery,orthopedic surgery,neurosurgery,otorhinolaryngologic surgery,cardiothoracic surgery),types of medication and treatment of the cohort patients in the peri-anaesthetic period were analyzed.Indicators with statistical significance(P<0.1)in conditional univariate logistic regression were subjected to multivariate conditional logistic regression analysis to identify the independent risk factors of intraoperative severe anaphylaxis.Results A total of 202857 patients underwent surgery.The incidence of severe intraoperative allergic reactions was 3.8/10000,of which gradeⅡ,Ⅲ,Ⅳallergy accounted for 41(54.7%),32(42.7%),2(2.6%),respectively.Multivariate conditions logistic regression showed that the history of allergy(OR=3.136,95%CI 1.027-9.579,P=0.045),intraoperative using of cis-atracurium(OR=5.248,95%CI 1.481-18.589,P=0.010),intraoperative infusion of hydroxyethyl starch 130/0.4(OR=8.418,95%CI 3.779-18.752,P<0.001),and intraoperative infusion of allogeneic plasma(OR=6.100,95%CI 2.363-15.745,P<0.001)were the independent risk factors of severe intraoperative anaphylaxis.Conclusion History of allergy,intraoperative using of cis-atracurium,intraoperative infusion of hydroxyethyl starch 130/0.4,and intraoperative infusion of plasma are the independent risk factors of intraoperative severe anaphylaxis.