麻醉中的免疫病例.pptVIP

An immunological case in anesthesia 曹世长 温明新 刘凤悦 杨高第 任 刚 张全海 张庆彬 夏 霏 Analysis The patient did not have anesthesia allergies, but after the initial injection of anesthetics,he experienced adverse reactions.After adjusting the tracheal tube, and the application of anti-inflammatory drugs,adverse reactions were eliminated. The second time only Succinylcholine (司可林) was used, an adverse reaction still happened, so Succinylcholine plays an important role. Diagnosis The patient suffered from type-I hypersensitivity reaction and anaphylaxis-like reaction(类过敏反应) . So systemic anaphylaxis happened. Mechanism Any intravenous anesthesia drugs may cause hypersensitivity reactions and anaphylaxis-like reaction . The first reason is the injection of neuromuscular blocking agent . Because of the unique molecular structure characteristics of neuromuscular blocking agent ,it is a potential allergen. Adverse reactions are Type I hypersensitivity reaction and anaphylaxis-like reaction .Type I hypersensitivity is immune mechanism. In anaphylaxis-like reaction , drugs stimulate mast cells and basophils directly and the cells release chemicals, so it is non-immunologic mechanism.It occurs without specific antibody. If that is the first injection and adverse reactions happened, anaphylaxis-like reaction should be highly suspected . In addition,in type I hypersensitivity, Th2 cells which supply second signals for B cells activation secret IL-13 and cause asthma without IgE, suggesting that activated Th2 cells in the initial injection of allergens may also cause asthma. Initial reaction : anaphylaxis-like reaction and Th2 cell-mediated response happened and tracheal tubes were placed too deep. Second reaction : mainly type I hypersensitivity happened. Anaphylaxis-like reaction also participated. Although type I hypersensitivity and anaphylaxis-like reaction activate mast cells and basophils differently, But released chemicals through degranulation are