摘要
1例74岁男性患者因腰椎管狭窄症行全麻下腰椎后路减压融合内固定术。围术期应用七氟烷(1.5%)+丙泊酚+舒芬太尼+依托咪酯+顺阿曲库铵复合麻醉,地塞米松预防过敏,头孢呋辛预防感染,羟乙基淀粉稳定血流动力学。术中持续给予七氟烷(1.5%)吸入,瑞芬太尼300 μg/h和去氧肾上腺素0.4 mg/h静脉泵入。手术过程顺利,4 h内未出现过敏反应。手术临近结束时,于患者手术伤口局部喷撒万古霉素粉末1 g,15 min后静脉注射氟比洛芬酯50 mg。用药20 min后,患者突然出现俯卧位指脉氧饱和度测不出,即测血压45/20 mmHg(1 mmHg=0.133 kPa)。考虑严重过敏反应,立即予以开放中心静脉,静脉注射肾上腺素、去氧肾上腺素,间断静脉注射去甲肾上腺素;10 min后指脉氧饱和度恢复至1.00;15 min后血压整体平稳,予乳酸钠林格注射液2 000 ml静脉滴注。5 h后患者情况稳定,转出手术室。考虑该例患者严重过敏反应与万古霉素和氟比洛芬酯有关。
A 74-year-old male patient underwent posterior lumbar decompression,fusion,and internal fixation under general anesthesia for lumbar spinal stenosis.Sevoflurane(1.5%),propofol,sufentanil,etomidate,and cisatracurium were used for anesthesia,followed by dexamethasone for allergy prevention,cefuroxime for in feet io n prevention,and hydroxyethyl starch for hemodynamic stabilization.Inhalation of sevoflurane(1.5%)and introvenous pumping of remifentanil 300μg/h and phenylephrine 0.4 mg/h were given for anesthesia maintenanee during the operation.The operation process went smoothly and no anaphylaxis occurred within 4 hours.At the end of the operation,vancomycin powder 1g was given topically at the surgical site and intravenous injection of flurbiprofen axetil 50 mg was given 15 minutes later.Twenty minutes after the medication,the patient's pulse oxygen saturation was not detectable and the blood pressure fell to 45/20 mmHg.Severe anaphylaxis was diagnosed.The central vein was immediately switched on,and intravenous injection of epinephrine and norepinephrine and intermittently intravenous injection of norepinephrine were given.Ten minutes later,the pulse oxygen saturation returned to 1.00 and 15 minutes later,the blood pressure became stable.At the same time,2000 ml of sodium lactate Ringer's injection was given.The patient was in stable condition 5 hours later and was transferred out of the operating room.The severe anaphylaxis in this patient was considered to be related to vancomycin and flurbiprofen axetil.
作者
陈逸
应颖秋
李姗姗
杨丽
翟所迪
Chen Yi;Ying Yingqiu;Li Shanshan;Yang Li;Zhai Suodi(Department of Pharmacy,Peking University Third Hospital,Beijing 100191,China;Department of Pharmacy Administration and Clinical Pharmacy,School of Pharmaceutical Science,Peking University,Beijing 100191,China;Institute for Drug Evaluation,Peking University Health Science Center,Beijing 100191,China)
出处
《药物不良反应杂志》
CSCD
2020年第11期662-664,共3页
Adverse Drug Reactions Journal
