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| 术中严重过敏反应的危险因素分析 |
| Analysis of risk factors for intraoperative severe anaphylaxis |
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| DOI：10.12089/jca.2022.04.009 |
| 中文关键词: 围术期 严重过敏反应 危险因素 |
| 英文关键词: Perioperative Severe anaphylaxis Risk factors |
| 基金项目:广西重点研发计划（桂科AB20159019）；国家重点研发计划（2018YFC2001905） |
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| 中文摘要: |
目的 分析术中发生严重过敏反应的危险因素。
方法 选择2014年1月至2019年12月手术患者375例，符合《斯堪的纳维亚围麻醉期过敏反应诊断和处理指南》Ⅱ—Ⅴ级过敏反应为过敏组（n=75），采用巢式病例-对照研究进行匹配，选择未发生过敏反应的手术患者为对照组（n=300）。分析患者的一般资料、手术方式、麻醉方式、手术类型（腹部手术、骨科手术、神经外科手术、耳鼻喉手术、心胸外科手术）、围麻醉期药物种类及治疗情况等，将单因素Logistic分析中P＜0.1的因素纳入多因素Logistic回归分析术中发生严重过敏反应的独立危险因素。
结果 手术患者共有202 857例，发生术中严重过敏反应的有77例(3.8/10 000)，其中发生Ⅱ、Ⅲ、Ⅳ级过敏反应的分别有41例（54.7%）、32例（42.7%）、2例（2.6%）。多因素Logistic分析显示既往过敏史（OR=3.136，95%CI 1.027～9.579，P=0.045）、术中应用顺式阿曲库铵（OR=5.248，95%CI 1.481～18.589，P=0.010）、术中输注羟乙基淀粉130/0.4（OR=8.418，95%CI 3.779～18.752，P＜0.001）、术中输注异体血浆（OR=6.100，95%CI 2.363～15.745，P＜0.001）为术中严重过敏反应的独立危险因素。
结论 既往过敏史、术中使用顺式阿曲库铵、术中输注羟乙基淀粉130/0.4、术中输注异体血浆为术中发生严重过敏反应的独立危险因素。 |
| 英文摘要: |
Objective To identify the risk factors of intraoperative severe anaphylaxis.
Methods A total of 375 patients who underwent surgery from January 2014 to December 2019 were selected. According to the Scandinavian Clinical Practice Guidelines on the Diagnosis, Management and Follow-up of Anaphylaxis during Anesthesia, grade Ⅱ-Ⅴ anaphylaxis were selected as the allergic group (n = 75). Using the design method of the Nested case-control study, the patients who did not have an anaphylaxis were selected as the control group (n = 300). The general characteristics, methods of surgery, anesthesia methods, types of surgery (abdominal surgery, orthopedic surgery, neurosurgery, otorhinolaryngologic surgery, cardiothoracic surgery), types of medication and treatment of the cohort patients in the peri-anaesthetic period were analyzed. Indicators with statistical significance (P < 0.1) in conditional univariate logistic regression were subjected to multivariate conditional logistic regression analysis to identify the independent risk factors of intraoperative severe anaphylaxis.
Results A total of 202 857 patients underwent surgery. The incidence of severe intraoperative allergic reactions was 3.8/10 000, of which grade Ⅱ, Ⅲ, Ⅳ allergy accounted for 41(54.7%), 32(42.7%), 2(2.6%), respectively. Multivariate conditions logistic regression showed that the history of allergy (OR = 3.136, 95% CI 1.027-9.579, P = 0.045), intraoperative using of cis-atracurium (OR = 5.248, 95% CI 1.481-18.589, P = 0.010), intraoperative infusion of hydroxyethyl starch 130/0.4 (OR = 8.418, 95% CI 3.779-18.752, P < 0.001), and intraoperative infusion of allogeneic plasma(OR = 6.100, 95% CI 2.363-15.745, P < 0.001) were the independent risk factors of severe intraoperative anaphylaxis.
Conclusion History of allergy, intraoperative using of cis-atracurium, intraoperative infusion of hydroxyethyl starch 130/0.4, and intraoperative infusion of plasma are the independent risk factors of intraoperative severe anaphylaxis. |
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