英国发布围术期过敏反应处理新指南

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　　大不列颠及北爱尔兰联合王国麻醉医师有了新的指导方针，用于手术过程中预防和处置突发事件。
　　新指南由大不列颠及北爱尔兰联合王国麻醉师协会(AAGBI)共同制定，包括初级管理和药物咨询，二级管理，以及阐述引起过敏反应的原因。这些准则基于AAGBI工作组的一个回顾性研究，发现对神经肌肉阻断剂的过敏和对医生带的手术乳胶手套过敏通常在女性患者中更常见;抗生素过敏症在吸烟者是比较常见的，可能是因为增加对呼吸道重复性刺激；皮肤过敏，哮喘史，食物过敏患者似乎对乳胶更为敏感;哮喘病患者或服用阻断药物的患者出现更严重反应的几率会更大；对牙膏、洗涤剂、洗发水和咳嗽药过敏的人可能对肌肉阻断剂更敏感。
　　另一方面，该小组发现对局部麻醉剂的过敏反应比较少见，因此他们建议，局部麻醉而不是全身麻醉可能会减少一些过敏性疾病。
　　详细的指南可在AAGBI网站上获得，并可用A4打印纸打印，保存在手术室内，因此可以在紧急情况下随时使用。

The Association is pleased to announce that 'Suspected Anaphylactic Reactions Associated with Anaesthesia 4' and the associated laminated card are available for download. Below is a summary of recommendations. (1) The AAGBI has published guidance on management of anaphylaxis during anaesthesia in 1990, 1995 and 2003. This 2009 update was necessary to disseminate new information.

(2) Death or permanent disability from anaphylaxis in anaesthesia may be avoidable if the reaction is recognised early and managed optimally.

(3) Recognition of anaphylaxis during anaesthesia is usually delayed because key features such as hypotension and bronchospasm more commonly have a different cause.

(4) Initial management of anaphylaxis should follow the ABC approach. Adrenaline (epinephrine) is the most effective drug in anaphylaxis and should be given as early as possible.

(5) If anaphylaxis is suspected during anaesthesia, it is the anaesthetist’s responsibility to ensure the patient is referred for investigation.

(6) Serum mast cell tryptase levels may help the retrospective diagnosis of anaphylaxis: appropriate blood samples should be sent for analysis.

(7) Specialist (allergist) knowledge is needed to interpret investigations for anaesthetic anaphylaxis, including sensitivity and specificity of each test used. Specialist (anaesthetist) knowledge is needed to recognise possible non-allergic causes for the ‘reaction’. Optimal investigation of suspected reactions is therefore more likely with the collaboration of both specialties.

(8) Details of specialist centres for the investigation of suspected anaphylaxis during anaesthesia may be found on the AAGBI website http://www.aagbi.org.

(9) Cases of anaphylaxis occurring during anaesthesia should be reported to the Medicines Control Agency and the AAGBI National Anaesthetic Anaphylaxis Database. Reports are more valuable if the diagnosis is recorded following specialist investigation of the reaction.

(10) This guidance recommends that all Departments of Anaesthesia should identify a Consultant Anaesthetist who is Clinical Lead for anaesthetic anaphylaxis.

>Download a full version of the safety guideline (PDF)

liu10113

谢谢了，回去打一份，贴到科室墙上！

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医学职称网----------------w w w.9 9 9y x w.c n

方丈爱飘柔

非常感谢，最近碰到过敏的病人总是有点手忙脚乱的