罗库溴铵致过敏性休克1例

全身麻醉诱导期间需短时间内应用多种药物，药物起效的同时可能会发生过敏性反应。过敏性反应的临床表现多样，包括皮疹、颜面水肿、呼吸道痉挛、血压急剧下降、心率增快或减慢等，过敏性休克罕见却极其危险，抢救不及时可威胁生命。麻醉状态下，尤其是全身麻醉，患者不能及时提出不适主诉，亦有手术无菌单等覆盖身体，这些因素都会造成麻醉师对过敏反应发现的不及时，从而可能延误治疗。因此，在麻醉过程中应对患者皮肤状态以及监测指标给予足够的重视。 肌松药是全身麻醉用药的重要组成部分，其化学结构中含有的季铵基团是导致麻醉过程中发生过敏反应的常见原因。肌松药相关性过敏反应占全部麻醉相关性过敏反应的60%［1］。本文报告1例麻醉诱导期间发生过敏性休克的病例，并回顾了麻醉期间过敏反应的诊断、处理等相关资料。

Rocuronium anesthesia induced anaphylactic shock:a case report

SUMMARY Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen , and it could be an unpre-dictable and life-threatening cause during anesthesia .The main purpose of this paper is to report a case of anaphy-lactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period .A 63-year-old man, with a mass on his adrenal , was scheduled to a laparoscopic adrenal tumor excision .During the anesthesia induction period , after administrated sul-fentanil, propofol and rocuronium , the blood pressure was decreased and the heart rate was increased .Then, the patient had rash on his whole body and developed an anaphylactic shock .After being treated with the anti-allergic agents and norepinephrine , the rash disappeared and the vital sign become stable .The patient felt nothing uncom-fortable during the two weeks ’ follow-up.Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period .The most common inducements are muscle relaxant , latex and antibiotics .Anaphylactic reac-tions in the perioperative period are often serious and potentially life-threatening conditions , involving multiple or-gan systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils .Before anesthesia , we should acquire the allergic history .During the anesthesia period , the vi-tal sign and the skin should be observed carefully .