疑似麻醉過程用藥所引起過敏性休克反應案例報告

Suspected Anaphylactic Shock Associated with Drugs Used in Anesthesia: A Case Report

林小卿(Hsiao-Ching Lin) ； 蘇慧真(Hui-Chen Su) ； 林双金(Shun-Jin Lin) ； 王慧瑜(Hui-Yu Wang)

《臺灣臨床藥學雜誌》 21卷1期 (2013/03) Pp. 79-88

https://doi.org/10.6168/FJCP.2013.2101.10

摘要

過敏性休克反應為一作用迅速且可能致命的過敏性反應，除了應及早治療減輕危害之外，辨別出導因，防止日後醫師再次選用相同麻醉劑，更是重要。本案例為一55歲前列腺癌病人，疑似因手術麻醉劑引發過敏性休克反應，經術中給予升壓劑、類固醇、電擊等治療處置，最後裝置葉克膜轉入加護病房照顧（ICU），並於二天後順利移除葉克膜，但意識仍未恢復，經追蹤後發現腦部多處梗塞及出血，經治療後雖腦水腫情形改善，且意識恢復，但因仍無法順利脫離呼吸器，必須進行氣切手術。麻醉過程，醫療團隊經審慎評估後，避開疑似過敏藥物，並於術前投予預防性藥物，有效的防止過敏性休克反應再次發生。

關鍵字

過敏性休克 ； 麻醉劑 ； 肌肉鬆弛劑

並列摘要

Anaphylaxis is a serious allergic reaction that is rapid at onset and is potentially fatal. In addition to early recognition and prompt management, identification of the offending drug is crucial to prevent future exposure to the same anesthetics. This is a case report of a 55-year-old man with prostate cancer who developed suspected anaphylactic shock associated with anesthetics before surgery. This patient was given Vasopressor, steroid and CPR, and transferred to intensive care unit (ICU) for extracorporeal membrane oxygenation (ECMO) with further care. ECMO was removed successfully in two days. However, the patient suffered from brain multiple infarction with hemorrhagic transformation and brain edema, and failed weaning off the ventilator despite treatment. Therefore, tracheostomy was planned. This time, the medical team conducted a thorough assessment and used premedication to prevent any anaphylactic reaction.

並列關鍵字

Anaphylaxis ； Anesthetics ； Muscle relaxants