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目的分析气道压力增高在判断体外循环手术中鱼精蛋白过敏反应中的价值。方法择期手术的先天性心脏病患儿402例,静吸复合全身麻醉,体外循环结束后,经静脉推注1.5倍肝素剂量鱼精蛋白,输注速度为每分钟1 mg/kg,每隔1分钟记录气道压力(Paw),同时监测心率(HR)、血压(BP)、指脉搏血氧饱和度(SpO_2)、中心静脉压(CVP)、肺动脉压(PAP)和呼气末二氧化碳分压(P_(ET)CO_2)。平均动脉压(MBP)下降≥10 mm Hg确定为鱼精蛋白毒性反应,下降<30 mm Hg为轻度反应,/>30 mmHg为中重度反应,分析Paw增高与鱼精蛋白过敏反应的关系,并判断其敏感性。结果发生鱼精蛋白反应21例,发生率为5.2%,其中5例为轻度反应,仅表现为血压下降;16例为严重过敏反应,Paw均升高且明显早于血压下降,提前(42.4±19.4)秒,灵敏性仅次于PAP增高,差异有显著性意义(P<0.05)。结论在鱼精蛋白中和过程中,气道压力增高能早期提示鱼精蛋白中、重度过敏反应。
Objective To analyze the value of airway pressure increase in the determination of protamine allergy in cardiopulmonary bypass. Methods 402 cases of congenital heart disease undergoing elective surgery were treated with static inhalation combined with general anesthesia. After cardiopulmonary bypass, a 1.5-fold heparin dose of protamine was intravenously injected at a rate of 1 mg / kg per minute at intervals of 1 (Paw) was recorded while monitoring heart rate (HR), blood pressure (BP), pulse oxygen saturation (SpO2), central venous pressure (CVP), pulmonary arterial pressure (PAP) and end-tidal carbon dioxide partial pressure (P_ (ET) CO_2). Mean arterial pressure (MBP) decreased ≥ 10 mm Hg identified as protamine toxicity, decreased <30 mm Hg mild reaction, /> 30 mmHg for moderate to severe reaction, Paw increased analysis and protracted allergic reactions, And judge its sensitivity. Results There were 21 cases of protamine reaction, the incidence rate was 5.2%, of which 5 cases were mild reactions, showing only a drop in blood pressure; 16 cases were severe allergic reactions, Paw were elevated and significantly earlier than the blood pressure decreased (42.4 ± 19.4) seconds, second only to the sensitivity of PAP increased, the difference was significant (P <0.05). Conclusion During the process of protamine neutralization, airway pressure increase can prompt severe and moderate hypersensitivity reaction of protamine.