麻醉诱导前多药联用致Kounis综合征  

Kounis syndrome caused by multidrug combination before anesthesia induction

作　　者：沈江华[1] 刘淼[2] 刘琛[1] 刘乾 褚燕琦[1] 冯雪辛[2] Shen Jianghua;Liu Miao;Liu Chen;Liu Qian;Chu Yanqi;Feng Xuexin(Department of Pharmacy,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Anesthesiology and Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院药学部,北京100053 [2]首都医科大学宣武医院手术麻醉科,北京100053

出　　处：《药物不良反应杂志》2024年第10期627-630,共4页Adverse Drug Reactions Journal

摘　　要：1例50岁男性患者因会厌囊肿拟在全麻下行会厌肿物切除术,麻醉诱导前,麻醉医师给患者依次静脉注射地塞米松、甲泼尼龙、咪达唑仑和昂丹司琼,2 min后患者诉心悸、腹部痉挛性疼痛,并嘴唇发绀、胸前及躯干部皮肤呈花斑状改变,心电监护仪示心率175次/min,袖带血压测不出,血氧饱和度0.76,随后患者呼之不应。立即给予面罩吸氧并加压通气,2次给予艾司洛尔20 mg静脉注射等抢救措施,患者意识恢复,心率逐渐降至60次/min(窦性心律),血压升至74/50 mmHg(1 mmHg=0.133 kPa),给予去甲肾上腺素8μg/min持续静脉泵入;25 min后床旁心电图示心房颤动伴室内差异性传导,心肌损伤或急性心肌梗死改变,QT间期延长;给予呋塞米40 mg静脉注射,上述症状好转,血压恢复至110~120/70 mmHg,血氧饱和度1.00,胸前及躯干部皮肤花斑消失,腹部疼痛好转。医师与药师对患者不良反应进行评估,考虑其为糖皮质激素、咪达唑仑和昂丹司琼多药联用导致的Ⅰ型Kounis综合征的可能性大。A 50-year-old male patient was scheduled to undergo epiglottic mass resection under general anesthesia due to an epiglottic cyst.Before anesthesia induction,the patient received dexamethasone,methylprednisolone,midazolam,and ondansetron by intravenous injectionin sequence.After 2 minutes,the patient complained of palpitations,abdominal spasmodic pain,cyanosis of the lips,and patchy changes in the skin on the chest and body.The electrocardiogram monitor showed a heart rate of 175 beats per minute,but his cuff blood pressure cannot be measured.His blood oxygen saturation was 0.76,and he did not respond to the call afterwards.Oxygen through a face mask and pressure ventilation,intravenous injection of 20 mg of esmolol twice were given immediately.The patient′s consciousness recovered,the heart rate gradually decreased to 60 beats per minute(sinus rhythm),and the blood pressure increased to 74/50 mmHg.Continuous IV pumping of norepinephrine 8μg/min was given.After 25 minutes,the patient′s bedside electrocardiogram showed atrial fibrillation with ventricular differential conduction,myocardial injury or acute myocardial infarction,and QT interval prolongation.Then intravenous injection of furosemide 40 mg was given,his above symptoms were improved,his blood pressure recovered to 110-120/70 mmHg,blood oxygen saturation was 1.00,the skin spots on his chest and body disappeared,and his abdominal pain was alleviated.Anesthesiologists and pharmacists evaluated the patient′s adverse reactions and considered that there was a high possibility of type I Kounis syndrome caused by the combination of glucocorticoids,midazolam,and ondansetron.

关 键 词：糖皮质激素 咪达唑仑 昂丹司琼 Kounis综合征 麻醉诱导 

分 类 号：R969.3[医药卫生—药理学]