Ootaki C, Uchida T, Matsutani R, Fukunaga H
Department of Anesthesia, Nishinomiya Municipal Central Hospital.
Masui. 2000 Oct;49(10):1109-14.
A 51-yr-old woman developed pulmonary embolism while undergoing surgery for breast cancer with Auchincloss method. General anesthesia was maintained with propofol and fentanyl. The course of anesthesia and operation were uneventful until the skin was sutured, when unexplained severe circulatory collapse developed. A widely dissociated EtCO2-PaCO2 suggested pulmonary embolism. The pulmonary circulation was restored 10 minutes after the start of heparin therapy, and the intravenous heparin administration was continued. The patient was extubated uneventfully 24 hours postoperatively. Lung perfusion scintigrams showed defect in right lower lungs (S 6, S 9). Venograms of the lower extremity disclosed thrombosis of the right popliteal vein. Furthermore, lupus anticoagulant was noted in the serum. Patients with antiphospholipid syndrome often develop pulmonary complications including pulmonary embolism and pulmonary hypertension. Intra-operative pulmonary embolism associated with lupus anticoagulant is a rare case.
一名51岁女性在采用Auchincloss法进行乳腺癌手术时发生了肺栓塞。全身麻醉采用丙泊酚和芬太尼维持。在皮肤缝合前，麻醉和手术过程顺利，之后突然出现不明原因的严重循环衰竭。EtCO2与PaCO2的显著分离提示肺栓塞。肝素治疗开始10分钟后肺循环恢复，静脉肝素输注持续进行。患者术后24小时顺利拔管。肺灌注闪烁扫描显示右下肺（S 6、S 9）有缺损。下肢静脉造影显示右腘静脉血栓形成。此外，血清中检测到狼疮抗凝物。抗磷脂综合征患者常发生包括肺栓塞和肺动脉高压在内的肺部并发症。术中与狼疮抗凝物相关的肺栓塞是罕见病例。
