论文部分内容阅读
患者女,17岁。因患慢性扁桃体炎于1997年12月22日上午行扁桃体切除术。患者普鲁卡因皮试阳性,故术中用0.5%利多卡因15ml行左侧扁桃体周围浸润麻醉,麻醉生效后,切除左侧扁桃体,止血后,准备切除右侧扁桃体时,患者突然全身抽搐,意识丧失。牙关紧闭。此时呼吸停止,大动脉搏动消失。立即让患者自己平卧位,并胸外按压心脏,呼吸机面罩给氧,静推地塞米松10mg,10%葡萄糖酸钙10ml加入5%葡萄糖100ml中静滴,约2min后患者意识恢复,自主呼吸恢复,P100/min,BP13/8kPa,继续低流量吸氧,暂停手术,送回病房观察。讨论此例所用0.5%利多卡因15ml中仅含利多卡因75mg,远非中毒剂量,故考虑此例系利多卡因引起的过敏性休克。利多卡因作为半抗原刺激机体肥大细胞、嗜碱性粒细胞产生组织胺、缓激肽等
Female patient, 17 years old. Due to chronic tonsillitis in December 22, 1997 morning tonsillectomy. Patients with procaine skin test positive, so the surgery with 0.5% lidocaine 15ml left around the tonsil infiltration anesthesia, anesthesia effect, the removal of the left tonsil, hemostasis, the preparation for resection of the right tonsil, the patient suddenly systemic twitches Loss of consciousness. Tight shut. Breathing stopped at this time, the aortic pulse disappeared. Immediately let patients own supine position and thoracic heart pressure, ventilator mask oxygen, intravenous dexamethasone 10mg, 10% calcium gluconate 10ml added 5% glucose 100ml intravenous infusion, about 2min after the recovery of patient awareness, autonomy Respiratory recovery, P100 / min, BP13 / 8kPa, continue low flow oxygen, suspension of surgery, sent back to the ward observation. Discussion 0.5% lidocaine 0.5% used in this case only contains lidocaine 75mg, far from the toxic dose, so consider this case of lidocaine-induced anaphylactic shock. Lidocaine as a hapten to stimulate the body mast cells, basophils produce histamine, bradykinin, etc.