- 期刊
Fatal Anaphylactoid Shock Associated with Protamine for Heparin Reversal during Anesthesia
開心手術麻醉中發生致命性過敏反應之病例報告
摘要
一位19歲女性，接受心室中隔缺損修補手術，病人無特殊病史，無藥物或食物過敏。不幸於同一心臟手術麻醉期間，發生兩次藥物過敏反應。其一是於麻醉誘導後給予抗生素(gentamcin及vancomycin)發生休克現象，經緊急處置後，病人回復腹正常。另一次是當此手術結束時，給予protamine以中和heparin之作用，產生致命性的過敏休克反應，雖即刻給予積極度性藥物治療及即時重新建立體外循環，但病人情況并未獲得改善而死亡。經由此致命性的過敏休克反應之病例，吾人將探討麻醉過程中所產生之藥物過敏反應及protamine所產生之毒性，副作用以及致命性之過敏反應，并討論其預防與治療之道。
並列摘要
A 19-year-old female was scheduled for elective surgery of repair of ventricular septal defect (VSD). She had no known previous food or drug allergy history. She was not previously exposed to protamine and did not have any of the risk factors pointing to protamine hypersensitivity reaction. Unfortunately there were two anaphylactoid shocks occurring during this surgery. One was caused by intravenous (IV) administration of antibiotics, and the other happened following W drip of protamine sulfate for reversal of systemic heparinization. She had none of the risk factors suggestive of hypersensitivity to drugs and was therefore considered not at risk for such severe adverse reactions which happened. This article was to discuss the anaphylactoid shock induced by antibiotics and protamine during anesthesia, and the prevention and management of such a reaction.
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