心脏手术围麻醉期过敏反应讲义.ppt

* 三、治疗 一旦出现典型症状，考虑出现过敏反应，须立即采取正确措施，稳定呼吸和循环系统，挽救患者生命。 1、。 （三）缓解支气管痉挛 1、吸入纯氧，必要时气管内插管，机械通气。 2、吸入沙丁胺醇或溴化异丙托铵。 3、给予吸入麻醉药，加深麻醉。 4、可静注氯胺酮1~2mg/kg和氨茶碱5~6mg/kg。 （四）静注肾上腺皮质激素 地塞米松抗炎作用强，作用持续时间长，水钠潴留副作用小，但起效慢，达峰时间长（12~24h），过敏反应时并非首选，宜选用不需代谢直接作用于其受体的氢化可的松，应立即静注琥珀酸氢化可的松1~2mg/kg，可6h后重复给予，24h不超过300mg。 * Epinephrine sometimes fails to restore the profound disturbances of cardiovascular homeostasis. This singularclinical entity is called anaphylactic shock refractory to catecholamines Therefore, some patients experiencing anaphylaxis refractory t epinephrine, norepinephrine, and/or phenylephrine were successfully treated with AVP injected at least 10–20 min after shock onset.29 AVP could therefore play a pivotal role in cases of catecholamine failure occurring during anaphylaxis. Nevertheless, it is important that both successful and unsuccessful uses of AVP during resuscitation attempts during anaphylaxis be reported, such that a fair assessment of its potential usefulness can be established. Sympathetic excess, either therapeutic or due to endogenous release, frequently results in hemodynamically significant tachycardia. This itself can result in myocardial or cerebrovascular ischemia, decreased cardiac output, or degeneration into ventricular dysrhythmias, even in the absence of coronary artery disease.25 This scenario is exemplified by our third case, in which loss of SR occurred immediately after repeated injection of epinephrine. Patients receiving -blockers, such as our index patient (case 0),5 may not respond adequately to epinephrine.3,9,12,26 Regardless of the undesired effects associated with epinephrine (e.g., increased myocardial oxygen consumption, ventricular arrhythmias, and myocardial dysfunction), even high doses are recommended as first-line treatment of severe anaphylactic shock, along with aggressive intravascular volume expansion. This is followed by antihistamines and steroids and cardiopulmonary resuscitation if needed. A significant issue faced by cl