Botz G, Brock-Utne J G
Department of Anesthesia, Stanford University School of Medicine, CA 94305-5117.
Anaesthesia. 1992 Dec;47(12):1057-9. doi: 10.1111/j.1365-2044.1992.tb04203.x.
A patient in the right lateral position underwent left nephrectomy, after which he was placed supine for insertion of an arteriovenous fistula. All haemodynamic and respiratory values, including peak inspiratory pressure, were within normal limits and unchanged from baseline measurements. However, following the position change we noted that the amplitude of the electrocardiogram complexes were dramatically reduced. Our differential diagnosis included the possibility of a pneumothorax, which was subsequently confirmed by both physical examination and chest X ray. A chest drain was planned to be inserted at the end of the surgery, but 25 min after the electrocardiogram changes were noted, the patient's vital signs suddenly deteriorated. Emergency treatment for pneumothorax was instituted with good effect. The diagnostic use of the electrocardiogram and the treatment of this intra-operative pneumothorax are discussed.
一名处于右侧卧位的患者接受了左肾切除术，术后改为仰卧位以插入动静脉瘘。所有血流动力学和呼吸指标，包括吸气峰压，均在正常范围内，且与基线测量值相比无变化。然而，在体位改变后，我们注意到心电图复合波的幅度显著降低。我们的鉴别诊断包括气胸的可能性，随后通过体格检查和胸部X光证实了气胸。计划在手术结束时插入胸腔引流管，但在注意到心电图变化25分钟后，患者的生命体征突然恶化。对气胸进行了紧急治疗，效果良好。本文讨论了心电图在诊断中的应用以及术中气胸的治疗。
