异丙酚乳剂用于对鸡蛋、花生、大豆或其他豆类过敏的儿童
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Propofol use in children with allergies to egg, peanut, soybean or other legumes
背景与目的
异丙酚是儿童最常用的静脉麻醉药。然而，有人担忧异丙酚乳化剂用于对鸡蛋、花生、大豆或其他豆类过敏的儿童可能不安全。
方 法
我们对2005年至2015年在玛格丽特公主儿童医院接受全身麻醉的经免疫证实对鸡蛋、花生、大豆或豆类过敏的儿童进行了回顾性研究。并收集了关于患儿过敏诊断的详细资料，每种麻醉剂的使用，以及围术期发生的任何不良事件或过敏反应迹象。采用便利抽样法从我们的前瞻性麻醉研究数据库中选取确定未对任何已知食物过敏的患儿，并作为对照组。
结 果
我们确定了2608名儿童存在相关的临床食物过敏或敏感性，其中，304名有明确食物过敏史并接受了649次异丙酚麻醉，符合纳入标准。这些患儿中201人(66%)对鸡蛋过敏，226人(74%)对花生过敏，28人(9%)对大豆过敏，12人(4%)对豆类过敏。与892例无任何过敏史的异丙酚麻醉患儿进行比较。过敏组患儿中有10例(3%)，无过敏组患儿中有124例(14%)符合可能发生过敏反应的标准。在9名食物过敏组患儿中以及所有对照组患儿中，均发现了针对临床症状的有依据的非过敏解释。发生的一种可能的轻度过敏反应出现于既往有过脂肪乳剂过敏史的患儿身上。
结 论
异丙酚导致的真正严重的过敏反应是极其罕见的，通过食物过敏史来预测异丙酚是否会引起过敏是不可靠的。
原始文献摘要
Sommerfield DL, Lucas M, Schilling A, et al. Propofol use in children with allergies to egg, peanut, soybean or other legumes.[J].Anaesthesia 2019 May 11.DOI：10.1111/anae.14693.
Propofol is the most commonly administered intravenous agent for anaesthesia in children. However, there are concerns that the emulsified preparation may not be safe in children with an allergy to egg, peanut, soybean or other legumes. We conducted a retrospective study of children with immunologically confirmed egg, peanut, soybean or legume allergy and who underwent general anaesthesia at Princess Margaret Hospital for Children between 2005 and 2015. We extracted details regarding allergy diagnosis, each anaesthetic administered and any adverse events or signs of an allergic reaction in the peri-operative period. A convenience sample of patients without any known food allergies was identified from our prospective anaesthesia research database and acted as a control group. We identified 304 food-allergic children and 649 procedures where propofol
was administered. Of these, 201 (66%) had an egg allergy, 226 (74%) had a peanut allergy, 28 (9%) had a soybean allergy and 12 (4%) had a legume allergy. These were compared with 892 allergy-free patients who were exposed to propofol. In 10 (3%) allergy patients and 124 (14%) allergy-free patients, criteria for a possible allergic reaction were met. In nine of the food-allergic children and in all the controls valid non-allergic explanations for the clinical symptoms were found. One likely mild allergic reaction was experienced by a child with a previous history of intralipid allergy. We conclude that genuine serious allergic reaction to propofol is rare and is not reliably predicted by a history of food allergy.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：何幼芹 审校：王贵龙