Hayashida M, Matsushita F, Suzuki S, Misawa K
Department of Anesthesiology, Koritsu Showa Hospital, Kodaira.
Masui. 1992 Dec;41(12):1986-90.
A 72-year-old male underwent radical operation for cancer of the tongue. Anesthesia was maintained with the combination of enflurane-N2O-vecuronium and cervical epidural block. Five minutes after the cessation of the longstanding operation, VT and circulatory collapse occurred. After administration of lidocaine and ephedrine, VPC and ST elevation were noted, followed by VT and Vf. Cardioversion successfully restored sinus rhythm with no ST change, suggesting an episode of coronary artery spasm. The possible inducing factors in this case were hypotension and acute imbalance in autonomic nervous systems caused by hypovolemia, hypothermia, insufficient anesthetic depth, loss of surgical stress, neostigmine and epidural block. The authors reviewed case reports on coronary spasm, especially looking for possible inducing factors of coronary artery spasm during anesthesia.
一名72岁男性接受了舌癌根治手术。麻醉采用安氟醚 - 氧化亚氮 - 维库溴铵复合麻醉及颈部硬膜外阻滞。长时间手术结束5分钟后，出现了室性心动过速（VT）和循环衰竭。给予利多卡因和麻黄碱后，出现室性早搏（VPC）和ST段抬高，随后发生室性心动过速和心室颤动（Vf）。心脏复律成功恢复窦性心律，ST段无变化，提示为冠状动脉痉挛发作。该病例可能的诱发因素为低血压以及由低血容量、体温过低、麻醉深度不足、手术应激消失、新斯的明和硬膜外阻滞导致的自主神经系统急性失衡。作者回顾了关于冠状动脉痉挛的病例报告，尤其关注麻醉期间冠状动脉痉挛的可能诱发因素。
