疑似局部麻醉药“过敏”反应患者规范化诊断结果的分析  

Standardized diagnosis results of suspected local anesthetics allergy

作　　者：许凤[1] 张虹婷[1] 石楚琪 贾巧茹 张莉[1] 肖浩[1] 孟娟[1] Xu Feng;Zhang Hongting;Shi Chuqi;Jia Qiaoru;Zhang Li;Xiao Hao;Meng Juan(Allergy Center of West China Hospital,Sichuan University,Chengdu 610041,Chin)

机构地区：[1]四川大学华西医院变态反应中心,成都610041

出　　处：《中华预防医学杂志》2023年第12期2002-2009,共8页Chinese Journal of Preventive Medicine

基　　金：四川大学华西医院学科卓越发展1·3·5工程临床研究孵化项目(2018HXFH026);成都市科技局技术创新研发项目(2021-YF05-00473-SN);国家临床重点专科建设项目(TJZ202303)。

摘　　要：本研究回顾性分析使用局部麻醉药(local anesthetic,LA)的患者“过敏反应”诊断结果,以提高对LA过敏反应及其诊断的认识。收集2017年3月至2022年2月,因初步诊断“局部麻醉药过敏”于四川大学华西医院变态反应中心就诊,通过皮肤试验及药物激发试验进行规范化药物过敏诊断的24例患者临床资料及诊断结果,分析规范化诊断流程在LA过敏诊断中的价值。结果显示,纳入患者24例,年龄范围20~74岁,其中男性3例(12.5%),女性21例(87.5%)。有21例患者因既往使用LA后出现不良反应而初步诊断为“局部麻醉药过敏”,其中20例为速发型反应(用药后1 h内出现),1例为迟发型反应(用药1 h后出现)。通过规范化诊断,3例考虑LA过敏;1例排除LA过敏后,确诊为氯己定引起的严重过敏反应;其余17例患者考虑为心身反应7例(29.1%)、交感神经刺激症状3例(12.5%)、血管迷走性晕厥2例(8.3%)、药物毒副反应2例(8.3%),刺激性皮炎2例(8.3%),自发性荨麻疹1例(4.2%)。3例(12.5%)既往LA皮试阳性,再次行规范化诊断结果阴性,排除LA过敏。综上,真正局部麻醉药过敏反应较罕见,通过规范化皮肤试验、药物激发试验,绝大多数自诉“局部麻醉药过敏”的患者可排除过敏状况。对于高度怀疑LA诱发严重过敏反应者,根据诊疗需求可通过诊断试验为患者确定其他可作为安全替代的局部麻醉药。To review and investigate the diagnosis results of local anesthetics(LA)allergy and improve the understanding of LA allergy in clinician.From March 2017 to February 2022,a total of 24 patients were investigated in Allergy Center of West China Hospital,Sichuan University on suspicion of LA allergy.Clinical data and results of skin tests and drug provocation tests(DPT)with the suspected drugs were retrospectively evaluated.The value of standardized diagnostic protocol in the LA allergy were analyzed.The results showed that 24 patients(3 men/21 women)were included with age range from 20 to 74 years.Three cases(12.5%)were positive in previous LA skin tests and proved to be tolerated through standardized tests.Twenty-one patients were initially diagnosed as"LA allergy"because of adverse reactions after previous use of LA,including 20 cases of immediate-type reaction and 1 case of delayed-type reaction.Three cases were considered LA allergy through standardized diagnosis approaches,including skin tests and DPT.One patient was diagnosed with anaphylaxis caused by chlorhexidine.Of the remaining 17 patients,7 were considered as psychosomatic reactions(29.1%),3 of sympathetic nervous system conditions(12.5%),1 of spontaneous urticaria(4.2%),2 of vasovagal syncope(8.3%),drug side effects(8.3%),skin irritation(8.3%),respectively.In conclusion,true allergic reactions to LA are rare.Through standardized skin tests and DPT,allergy can be ruled out in the vast majority of patients who complain of"LA allergy".For patients who are highly suspected of LA inducing anaphylaxis,other local anesthetics that can be used as safe alternatives should be determined by diagnostic tests according to future needs.

关 键 词：局部麻醉药 不良反应 药物过敏 诊断 

分 类 号：R969[医药卫生—药理学]