縦隔腫瘍摘出術中に冠動脈攣縮による心停止をきたした1症例  [in Japanese] A Case of Cardiac Arrest Due to Coronary Spasm during Mediastinal Tumor Resection  [in Japanese]

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Abstract

  虚血性心疾患の既往のない患者の縦隔腫瘍摘出術中に心電図上ST上昇から心室頻拍・心室細動をきたしたが,冠拡張薬等の投与により回復し,後遺症なく経過した.術中・術後の心電図変化および術後の心エコー図(検査)所見より,心停止の原因として手術操作による循環変動に続く冠動脈攣縮を疑った.非心臓手術における冠攣縮の多くは虚血性心疾患の既往がない症例に発症し,その誘因として手術および麻酔のストレスが関与するとされている.冠動脈攣縮の危険因子では喫煙が突出している.本症例は術中の術操作による循環変動に加えて,冠動脈攣縮を起こしやすい患者背景があり,禁煙も不十分であったことが冠動脈攣縮の誘因となったと推察される.

  A 63-year-old man without history of ischemic heart disease was scheduled for mediastinal tumor resection. His blood pressure markedly decreased when surgeons separated the tumor from pulmonary veins. Following ST-segment elevation, ventricular fibrillation and ventricular tachycardia developed. The operation was completed and the patient awoke without neurological deficits. Coronary artery spasm was suspected from intraoperative electrocardiographic change and postoperative echographic examination of the cause of cardiac arrest. Hypotension due to the surgical procedure was suspected as the cause of the coronary spasm. In non-cardiac surgery, coronary spasm has been observed more commonly in patients without history of ischemic heart disease, the stress of the operation or anesthesia being responsible for coronary spasm. Smoking is considered to be a crucial risk factor for coronary spasm. In this case, intraoperative hypotension due to the surgical procedure, the clinical characteristics, and vascular endothelial dysfunction by smoking may have caused coronary artery spasm.

Journal

  • THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

    THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 35(1), 021-026, 2015

    THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA

Codes

  • NII Article ID (NAID)
    130004892973
  • Text Lang
    JPN
  • ISSN
    0285-4945
  • Data Source
    J-STAGE 
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