Fatal anaphylaxis with neuromuscular blocking agents: a risk factor and management analysis.
Fatal anaphylaxis with neuromuscular blocking agents: a risk factor and management analysis.
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DOI：
10.1111/all.12426
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发表时间：
2014-07-01
期刊：
影响因子：
12.4
通讯作者：
Mertes, P M
中科院分区：
文献类型：
--
作者：
Reitter, M;Petitpain, N;Mertes, P M
背景：神经肌肉阻滞剂(NMBAs)的过敏反应可能是严重的，甚至是致命的。我们的目的是评估法国NMBA过敏反应的死亡率，确定致命结果的风险因素，并描述被证明是致命的病例的处理。方法：查询法国国家药物警戒数据库，查找发生在2000年1月至2011年12月期间的NMBA过敏反应报告。结果：共检索到2,022例NMBA超敏反应病例，其中84例死亡(4.1%)。在1,247例严重NMBA过敏(3级和4级)患者中，多因素分析显示与致死结局相关的独立危险因素有：男性(女性：OR=0.4；95%CI0.2~0.7；P=0.0004)、急诊环境(OR=2.6；95%CI1.5~4.6；P=0.0007)、高血压病史(OR=2.5；95%CI1.5~4.4；P=0.0010)或其他心血管疾病史(OR=4.4；95%CI2.4~8.1P=0.0007)。
BACKGROUND: Anaphylactic reactions to neuromuscular blocking agents (NMBAs) can be severe and even fatal. Our aim was to evaluate mortality rate in France from anaphylactic reactions to NMBAs, to identify risk factors for a fatal outcome, and to describe management of the cases that proved fatal.METHODS: The French National Pharmacovigilance Database was queried for reports of NMBA anaphylaxis that occurred between January 2000 and December 2011. A questionnaire was sent to regional pharmacovigilance centers to obtain further information on the management of cases with a fatal outcome.RESULTS: Two thousand and twenty-two cases of NMBA hypersensitivity were retrieved, of which 84 were fatal (4.1%). Among the 1247 cases of severe NMBA anaphylaxis (grades 3 and 4), independent risk factors associated with a fatal outcome in a multivariate analysis were male gender (female gender: OR=0.4; 95% CI 0.2-0.7; P=0.0004), an emergency setting (OR=2.6; 95% CI 1.5-4.6; P=0.0007), a history of hypertension (OR=2.5; 95% CI 1.5-4.4; P=0.0010) or of other cardiovascular disease (OR=4.4; 95% CI 2.4-8.1; P