注射用血凝酶致全麻病人过敏性休克一例..doc

注射用血凝酶致全麻病人过敏性休克一例    毕业论文                                        摘要:                 患者男,45岁,60kg,ASAI级。因“第5腰椎滑脱”入院,拟在全麻下行切开复位,RF内固定术。患者既往健康,否认过敏史。术前血、尿、便常规,肝、肾功能、电解质、血糖、胸片均正常,心电图示窦缓。本文由作者李坤提供                                                                                                                                                                                                                                                                         AnaphylaticShockEvokedbyHemocoagulaseAtroxforInjectioninGeneralAnesthesia:ACaseReport 李坤何小康孔色红江西省新余市人民医院麻醉科338025KunLi,Xiao-kangHe,Se-hongKongDepartmentofAnesthesiology,JiangxiXinyuPeople’sHospital,Xinyu338025  1、临床资料患者男,45岁,60kg,ASAI级。因“第5腰椎滑脱”入院,拟在全麻下行切开复位,RF内固定术。患者既往健康,否认过敏史。术前血、尿、便常规,肝、肾功能、电解质、血糖、胸片均正常,心电图示窦缓。,安定10mg。入手术室HR70次/分,BP116/80mmHg,SPO298%。右颈内静脉穿刺置管,输注乳酸钠林格氏液,左侧桡动脉穿刺置管测桡动脉压。9:20麻醉诱导,依次静注咪唑安定2mg,***,丙泊酚50mg,维库溴铵6mg,气管内注射2%利多卡因5ml后行气管插管,机械通气。丙泊酚6mg?kg-1?h-1维持镇静。9:50改俯卧位,10:00手术开始,s血压110/78mmHg,HR62次/分。10:15从墨菲氏管注入血凝酶2u,5min内血压急剧下降,至30/10mmHg,心率上升到112次/分。同时气道阻力亦从12cmH2O上升至60cmH2O,考虑血凝酶过敏,先后3次静注多巴***2mg,地塞米松10mg,血压上升至50/30mmHg后复下降。停用丙泊酚,,血压回升至80/60mmHg,但不能维持,遂改肾上腺素1mg/h泵入,,血压维持在80~90/50~60mmHg。气道阻力逐渐下降至25cmH2O左右。12:30手术结束,术中出血量为400ml,共输液4000ml,红细胞4个单位,肾上腺素3mg,地塞米松20mg,多巴***20mg。手术结束后血压波动在80~90/50~60mmHg,心率90~100次/分,SPO2100%,CVP2-3cmH2O。继续肾上腺素1mg/h泵入,14:,16:30停用肾上腺素