Ueki R, Okutani R, Fukushima A, Kurehara H, Sasaki K, Tashiro C
Department of Anesthesiology, Hyogo College of Medicine, Nishinomiya.
Masui. 2000 Jan;49(1):37-9.
We encountered a rare case of complications at the time of central venous catheterization due to extrapleural hematoma. A 71-year-old woman was scheduled to undergo subtotal gastrectomy. After introduction of general anesthesia, a CVP catheter was inserted from the right jugular vein, but it was removed intraoperatively, because of poor dropping of the infusion fluid. A few minutes later, the blood pressure started to decrease. We considered that this symptom was derived from the surgical procedure, and rapid blood transfusion associated with administration of a vasopressor was performed. Postoperative chest X ray revealed poorly delineated right lung field, and hemothorax was suspected. However thoracic drainage resulted in an extremely small amount of blood-like fluid. The abnormal defect in the right pulmonary field was found to be an extrapleural hematoma by thoracic CT on the first postoperative day. The hematoma was reduced by subsequent management in 7 days, and the patient was discharged from the ICU without any further complications.
我们遇到了一例因胸膜外血肿导致中心静脉置管时出现罕见并发症的病例。一名71岁女性计划接受胃大部切除术。全身麻醉诱导后，从右颈静脉插入中心静脉压（CVP）导管，但因输液滴注不畅，术中将其拔除。几分钟后，血压开始下降。我们认为该症状源于手术操作，遂进行了快速输血并给予血管升压药。术后胸部X线显示右肺野轮廓不清，怀疑有血胸。然而，胸腔引流仅引出极少量血性液体。术后第1天胸部CT显示右肺野的异常缺损为胸膜外血肿。通过后续治疗，血肿在7天内缩小，患者从重症监护病房出院，未出现任何进一步并发症。
