神经外科手术患者围术期可疑过敏反应的临床分析

Analysis of suspected perioperative allergic reaction in patients undergoing neurosurgery

目的探讨全身麻醉下神经外科手术患者围术期发生可疑过敏反应的特点。方法选择2017年1月至2023年2月首都医科大学附属北京天坛医院接受全身麻醉下神经外科手术患者,通过电子病历系统检索发生可疑过敏反应患者,并根据过敏分级,将患者分为Ⅰ~Ⅱ级组和Ⅲ~Ⅳ级组。比较两组一般资料,可疑过敏反应的常见症状及处理方式。结果共纳入73283例患者,其中发生可疑过敏反应57例,可疑过敏反应的发生率为0.1%。57例过敏患者中男28例、女29例,年龄1~78岁,平均(41.0±21.0)岁;过敏反应Ⅰ级7例(12.3%)、Ⅱ级42例(73.7%),Ⅲ级8例(14.0%),无Ⅳ级过敏反应患者。57例患者中,同时出现心血管系统症状和皮肤症状13例(22.8%)、同时出现心血管系统症状和呼吸系统症状8例(14.0%)、同时出现三大系统症状4例(7.0%)。与Ⅲ~Ⅳ级组相比,Ⅰ~Ⅱ级组BMI较大[23.4(20.0,26.0)kg/m^(2)比20.2(19.6,22.7)kg/m^(2)]、过敏反应发生时BP下降程度较少[46.0(27.5,56.0)%比59.5(53.0,61.5)%]、心律失常发生比例较少(53.1%比100.0%),肾上腺素使用率较少(51.0%比100.0%),差异有统计学意义(均P<0.05)。结论全身麻醉下神经外科围术期可疑过敏反应的发生率较高,心血管系统症状是神经外科围手术期可疑过敏反应的最常见症状。临床中可结合可疑过敏原,早发现早诊断,及时治疗围术期可疑过敏反应,改善患者预后。

Objective To explore the characteristics of suspected perioperative allergic reaction in patients undergoing neurosurgery under general anesthesia.Methods Patients underwent neurosurgery under general anesthesia in Beijing Tiantan Hospital,Capital Medical University from January 2017 to February 2023 were selected.All patients with suspected allergic reaction were retrieved through the electronic medical record system and were divided into gradeⅠ-Ⅱgroup andⅢ-Ⅳgroup according to the allergy classification.The general information,common symptoms and treatment of suspected allergic reaction were compared between the two groups.Results A total of 73283 patients were included,among which 57 patients had suspected allergic reaction,and the incidence rate was 0.1%.Among the 57 patients,there were 28 males and 29 females aged from 1 to 78 years,with an average age of(41.0±21.0)years.There were seven patients(12.3%)with gradeⅠallergic reaction,42 patients(73.7%)with gradeⅡallergic reaction and eight patients(14.0%)with gradeⅢallergic reaction,and no patients with grade IV allergic reaction.Among the 57 patients,13 cases(22.8%)had symptoms of cardiovascular system and skin,eight cases(14.0%)had cardiovascular system and respiratory system,and four cases(7.0%)had symptoms of three major systems.Compared with gradeⅢ-Ⅳgroup,theⅠ-Ⅱgroup had a higher BMI[23.4(20.0,26.0)kg/m^(2)vs.20.2(19.6,22.7)kg/m^(2)],lesser decreased rate of BP[46.0(27.5,56.0)%vs.59.5(53.0,61.5)%],lesser incidence of arrhythmia(53.1%vs.100.0%),and lesser utilization rate of epinephrine(51.0%vs.100.0%),and the differences were statistically significant(all P<0.05).Conclusions The incidence of suspected perioperative allergic reaction in neurosurgery under general anesthesia is relatively high,and the cardiovascular system symptoms are the most common symptoms of suspected allergic reactions in neurosurgery perioperative period.In clinic,suspicious allergens can be combined with early detection and diagnosis,and suspicious allergic reactions during perioperative period can be treated in time to improve the prognosis of patients.