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作者报告1例由于输血引起过敏性休克,导致心脏骤停,经心肺复苏成功。患者,男,59岁、65kg,既往无过敏史。10年来因糖尿病经饮食控制,6年前曾有心绞痛发作,30年来有大量吸烟习惯。因怀疑上消化道出血入院,经紧急内窥镜检查诊断胃溃疡。当时病人主诉胸闷,烦躁不安,有先兆出血性休克现象,经输血、吸氧等治疗后稳定。血压、胸片、心电图和化验检查未见异常。静注安定10mg、芬太尼200μg和琥珀胆碱40mg后插气管导管,吸入N_2O-O_2-安氟醚(1～2％)维持麻醉加本可松保持肌松。在急症胃大部切除术中一度血压偏低,心电图显示ST段上升,经减浅麻醉和输血,血压回升,ST段恢复正常,顺利完成手术。但在输入第6个单位库血时,病人出现频脉、血压先上升随即急剧下降和徐脉,全身广泛荨麻疹,同时躁动不安。立即停止输血,静注类固醇激素和抗组胺药,并用多巴酚丁胺-多巴胺维持血压。随即出现房室传导阻滞,接着心跳停止。立即胸外心脏按压,同时经中心静脉测压管内注入异丙肾上腺素-肾上腺素以及静注氯化钙、碳酸氢钠等,5分钟后心脏复跳。约25分钟后
The authors report a case of anaphylactic shock due to blood transfusion, leading to cardiac arrest, successful cardiopulmonary resuscitation. Patient, male, 59 years old, 65kg, no history of allergy. 10 years due to diabetes diet control, angina pectoris occurred 6 years ago, 30 years have a lot of smoking habits. Due to suspected upper gastrointestinal bleeding admitted to hospital, the emergency endoscopy to diagnose gastric ulcer. At that time the patient complained of chest tightness, irritability, threatened hemorrhagic shock phenomenon, after transfusion, oxygen and other treatment was stable. Blood pressure, chest X-ray, ECG and laboratory tests showed no abnormalities. Intravenous diazepam 10mg, fentanyl 200μg and succinylcholine 40mg after intubation catheter, inhalation of N2O-O2-enflurane (1 to 2%) to maintain anesthesia plus the pine can hold muscle relaxants. In the acute gastrectomy partial low blood pressure, electrocardiogram showed ST segment increased by shallow anesthesia and blood transfusion, blood pressure rise, ST segment returned to normal, the successful completion of surgery. However, in the input of the 6th unit of library blood, the patient appeared in the frequency band, and then the blood pressure first rose sharply and then dropped sharply. The whole body was covered with urticaria and restless. Blood transfusions, IV steroids and antihistamines were stopped immediately and blood pressure was maintained with dobutamine-dopamine. Then atrioventricular block, followed by heartbeat. Immediate chest cardiac pressure, while central venous pressure tube isoproterenol - epinephrine and intravenous injection of calcium chloride, sodium bicarbonate, 5 minutes after the heart beating. About 25 minutes later