麻醉后监护室主动强制空气加温后发生胆碱能性荨麻疹：一例病例报告及文献复习。

文献信息

中文摘要

引言： 胆碱能性荨麻疹（CU）是慢性诱导性荨麻疹的一种亚型，由核心体温升高诱发。术后寒战和主动加温措施可能使麻醉后监护室（PACU）患者的核心体温升高，但该情境下的CU仍认识不足，且罕有报道。
病例介绍： 我们报告一例18岁男性，在全身麻醉下接受人工耳蜗植入术后于PACU发生急性CU。拔管后，患者出现术后寒战，并接受强制空气加温毯治疗。约10分钟后，其躯干出现弥漫性点状风团，中心苍白，周围有红晕，伴有严重瘙痒和心动过速（110-126次/分）。鉴于患者有运动和热诱发性皮疹病史，结合血流动力学稳定且无呼吸窘迫，临床发现更符合胆碱能性荨麻疹，而非严重围手术期超敏反应。
结果： 立即停止主动加温、静脉给予苯海拉明（20 mg）及环境降温后，症状在20分钟内迅速缓解。
结论： 本病例强调了术后寒战、主动加温和拔管相关交感神经激活在诱发CU中的协同病理生理作用。本病例提示，术后寒战、主动加温和拔管相关交感神经激活与CU发作在时间上紧密相继出现，可能共同促进了核心体温迅速升高和症状发作。CU可能发生于麻醉后恢复期间，应根据皮疹形态、生命体征和动态体温变化及时识别，与围手术期过敏反应相鉴别，并通过针对性体温控制和症状治疗进行管理。

英文摘要

INTRODUCTION: Cholinergic urticaria (CU), a subtype of chronic inducible urticaria, is triggered by elevations in core body temperature. Postoperative shivering and active warming measures may increase core body temperature in the post-anesthesia care unit (PACU), yet CU in this setting remains underrecognized and has rarely been reported.
CASE PRESENTATION: We report a case of an 18-year-old male who developed acute CU in the PACU following cochlear implantation under general anesthesia. After extubation, the patient exhibited postoperative shivering and was treated with a forced-air warming blanket. Approximately 10 min later, he developed diffuse punctate wheals with pale centers and peripheral erythematous halos across the trunk, accompanied by severe pruritus and tachycardia (110-126 beats/min). Given the patient's history of exercise- and heat-induced eruptions, together with stable hemodynamics and the absence of respiratory distress, the clinical findings were considered more consistent with cholinergic urticaria than with severe perioperative hypersensitivity.
RESULTS: Immediate cessation of active warming, intravenous diphenhydramine (20 mg), and environmental cooling resulted in rapid symptom relief within 20 min.
CONCLUSION: This case underscores the synergistic pathophysiology of postoperative shivering, active warming, and extubation-related sympathetic activation in precipitating CU. This case suggests that postoperative shivering, active warming, and extubation-related sympathetic activation occurred in close temporal sequence with the CU episode and may have jointly contributed to the rapid rise in core temperature and symptom onset. CU may occur during post-anesthesia recovery and should be promptly recognized on the basis of rash morphology, vital signs, and dynamic body temperature changes, differentiated from perioperative anaphylaxis, and managed with targeted temperature control and symptomatic treatment.