神经肌肉阻滞剂及其拮抗剂严重过敏反应的诊治与预防的研究进展

Updates in diagnosis,treatment,and prevention of anaphylaxis to neuromuscular blocking agents and their antagonists

围手术期药物严重过敏反应起病隐匿而迅速,可以危及生命,常使得手术被迫终止。目前认为,围手术期麻醉药物中引起严重过敏反应最常见的是神经肌肉阻滞剂(NMBAs)。随着麻醉学和外科医学的进步,全球麻醉及手术量越来越大,NMBAs使用机会越来越多,相应的超敏反应发生风险也随之越来越高。临床使用NMBAs的同时,也常会用到其拮抗剂,如新斯的明和舒更葡糖,这些药物在临床上也有越来越多的过敏报道。由于NMBAs及其拮抗剂引起过敏的机制复杂,不易确诊,且NMBAs之间交叉反应性强,因此,常难以选择替代药物。本文阐述了这些药物引起严重过敏反应的流行病学、病理机制、诊断方法与流程、急性期治疗以及预防方案的相关新近研究进展。

Anaphylaxis to perioperative drugs has an insidious and rapid onset,can be life-threatening,and often results in the suspension of surgery.Neuromuscular blocking agents(NMBAs)are currently considered to be the most common cause of anaphylactic reactions among anesthetic drugs.With the increasing amount of anesthesia and surgery in the world,there are more and more NMBAs use,and the corresponding allergic risk is also increasing.With the use of NMBAs,their antagonists,such as neostigmine and sugammadex,are often used too,which have more and more allergy reports in clinical practice.Due to the complex mechanism of allergy caused by NMBAs and their antagonists,it is difficult to find out the culprit drug.The cross-reactivity between NMBAs is common,so it is often difficult to choose alternative drugs.This article summarized the epidemiology,pathological mechanisms,diagnostic methods and procedures,immediate treatment,and prevention strategies of anaphylaxis caused by these drugs.