目前在澳洲的發生率為1:10,000～1:20,000(Fisher and Baldo, 1993),挪威則為 1:6000(Fasting and Gisvold, 2002)。據美國的retrospective cohort study研究，自1992至2010年共執行1,150,000項麻醉，其中有過敏性反應者:38名，發生率約0.003304%，38人中有15人取消手術，27人住進加護病房照護。

除了吸入麻醉劑，所有手術期間所使用的藥物、用品都可能引起過敏反應。神經肌肉阻斷劑（60％），其次是乳膠（12-16％）和抗生素（8％）。這三樣過敏原都是麻醉與手術必定會使用到的項目，肌肉鬆弛劑輔助氣管內管置放並且維持手術進行，乳膠則為廣泛使用醫療相關用品的成分(靜脈留置針/尿管/手術用無菌手套等)，而預防性抗生素亦為目前手術之常規。

過敏性休克來勢洶洶，會在極短的時間造成呼吸道腫脹，通氣困難缺氧 ; 同時合併急遽的血壓下降導致休克，使得手術被迫中斷甚至造成病人的死亡。台中榮總麻醉部過去十年發生大約50個過敏性休克案例，可見過敏性休克盛行率並不如想像中低，一直是個未知數。目前術中過敏性休克的診斷仰賴血液中類胰蛋白酶(tryptase)濃度的測定。英國麻醉醫師協會建議疑似過敏反應的病人，採取檢體的時間為：初步復甦後二小時，及發生後24小時兩個時間點來獲得基線值。當病人情況穩定後，會診過敏科醫師。4-6周後再做皮膚測試，希望找出可能的過敏原。

 

 

Keyword：Perioperative anaphylaxis, tryptase, gold nano-hemisphere array biochip, electrochemical impedance spectroscopy measurement

Perioperative anaphylaxis is a rare but life-threatening event, but it sometimes cannot be diagnosed immediately partly because these patients with general anesthetics could not tell the doctors their symptoms such as difficult in breathing, itch, swollen of mucosa and gastrointestinal discomfort etc. Anesthesiologists only can identify the possibility of anaphylaxis according to observing signs such as cardiovascular collapse, increased airway pressure and skin change. Except inhalation anesthetics, all perioperative intravenous anesthetics could cause anaphylaxis. Neuromuscular blocking agents (60%), followed by latex (12-16%) and antibiotics (8%) are the most common agents of perioperative anaphylaxis. In addition to clinical presentation, the elevated blood tryptase concentration could provide a reliable diagnosis of anaphylactic shock. Tryptase can be an indicator of mast cell activation during inflammatory process. Therefore, the British Society of Anesthesiologists recommends that patients with suspected allergic reactions should receive the tryptase tests, respectively at the initial resuscitation, the initial one hour after resuscitation, and the last 24 hours to get the baseline response. When the patients survived from the crisis, the skin test is the gold standard tool to identify the culprit drug and find a safe alternative drug for future exposures 4-6 weeks after perioperative anaphylaxis.