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1 病例介绍 患者女性,12岁,因慢性阑尾炎急性发作,手术治疗。入院时体温36.7℃,脉搏84次/分,呼吸16次/分,血压15/9kPa,即往有花粉过敏史。以急诊在氯胺酮麻醉下行阑尾切除术,术前30分钟肌注阿托品注射液0.5mg,安定王射液10mg,早6:30入手术室肌注氯眩酮注射液100mg,约1分钟后患者开始咳嗽,即询问患者平时是否咳嗽,回答不咳嗽,说话间仍咳嗽不止,因知道患者有过敏史当即意识到是氯胺酮所致气管支气管过敏性痉挛,立即给予面罩加压吸氧,静脉注射异丙嗪注射液25mg、地塞米松注射液5mg,此时病人意识丧失、口唇发绀、面色青紫、呼吸极度困难面罩给氧阻力很大,改为气管插管扶助呼吸,阻力仍很大,听诊双肺布满哮鸣音,测血压17.5/12kPa,心率120次/分、呼吸16次/分,静脉滴注5％碳酸氢钠100ml,5％葡萄糖注射液200ml加地塞米松注射液5mg,静脉推注5％葡萄糖注射液20mg加氨茶硷注射液100mg。7:00听诊双肺哮鸣音减轻,呼吸逐渐平稳,7:10听诊双肺呼吸音清晰,手术开始,术中没给任何麻醉药,于7:25分患者有疼痛感觉,并有气管刺激反应,手术于7:35分结束,术终吸痰后拔管,观察呼吸交换量满意,送回病房。 2 讨论 该患有过敏史,使用氯胺酮后表现为速发型过敏反应,症状严重,因此,在使用前
1 case description Female patients, aged 12, due to acute exacerbation of chronic appendicitis, surgical treatment. Admission, body temperature 36.7 ℃, pulse 84 beats / min, breathing 16 beats / min, blood pressure 15 / 9kPa, that is, to pollen allergy history. To emergency anesthesia in ketamine appendectomy, preoperative 30 minutes intramuscular injection of atropine injection 0.5mg, stability Wang shot 10mg, as early as 6:30 into the operating room intramuscular injection of chlorine dione ketone 100mg, about 1 minute after the patient started Cough, that is, ask the patient usually cough, the answer is not cough, coughing more than talking, because the patient has a history of allergies immediately aware of ketamine-induced bronchial bronchial allergic spasm, immediately give the mask pressurized oxygen, intravenous injection of isopropyl Injection of 25mg dexamethasone, dexamethasone injection 5mg, loss of patient awareness at this time, lips cyanosis, looking bruising, breathing extremely difficult Mask oxygen resistance is great, instead of tracheal intubation to help breathe, the resistance is still large, auscultation of the lungs Filled with wheeze, blood pressure 17.5 / 12kPa, heart rate 120 beats / min, breathing 16 beats / min, intravenous infusion of 5% sodium bicarbonate 100ml, 5% glucose injection 200ml plus dexamethasone injection 5mg, intravenous injection 5% glucose injection 20mg aminophylline injection 100mg. 7:00 auscultation lung lung wheeze relief, breathing gradually stable, 7:10 auscultation of lung breath sounds clear, the operation began, did not give any anesthesia during surgery, patients with pain at 7:25, and tracheal irritation Response, surgery at 7:35 pm, the end of sputum extubation, observation of respiratory exchange volume satisfaction, return to the ward. 2 Discussion This is a history of allergies, the use of ketamine showed immediate onset of allergic reactions, severe symptoms, therefore, before use