肝切除術中高K血症をきたした症例  [in Japanese] Hyperkalemia during hepatic surgery  [in Japanese]

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Author(s)

Abstract

肝切除術中, 肝血流遮断が原因と思われる高K血症を経験した. 肝血流を2時間2分間, 5回に亘って遮断したが, 5回目の遮断終了直前に, 突然心電図上, T波増高, QT時間延長, 心室性期外収縮が出現した. この時血清K値6.0mEq/L, 血糖値400mg/dl以上であった. 直ちにインシュリン, フロセミドを投与した結果, 30分後には心電図上の異常所見消失, 血清K値4.2mEq/Lと低下した. これは長時間の肝血流遮断により高度の低酸素障害を受けた残存肝細胞から, 血流再開に伴い循環血中に大量のカリウムが遊離したためと考えられる. 肝切除術中に肝血流遮断が行われた時は, 術中高K血症を起こすことがあるので, 注意深い観察が必要である.

We experienced one case of hyperkalemia assumed to be caused by the clamping of both the right hepatic artery and the right portal vein during the right hepatic segmentectomy. The clamping was performed repeatedly about five times for 122 minutes during the surgery. Just before the end of final clamping, the patient showed sudden change of ECG findings such as high T wave, prolonged QT interval, and PVCs and showed both increased serum potassium concentration about 6.0mEq/L and hyperglycemia more than 400mg/dl. Immediately the patient was treated with furosemide and insulin intravenously. About 30 minutes after the administration, the abnormal findings of ECG were diminished and also the serum potassium concentration returned to normal about 4.2mEq/L.<br>It may be concluded that the cause of the hyperkalemia was due to the massive potassium release from the liver cells of the clamped lobe. So we must take care of the occurence of the hyperkalemia during hepatic surgery with the repeated clamping of the vessels.

Journal

  • THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

    THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 4(2), 193-197, 1984

    THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA

Codes

  • NII Article ID (NAID)
    130003582005
  • Text Lang
    JPN
  • ISSN
    0285-4945
  • Data Source
    J-STAGE 
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