Kobayashi Takashi, Nagata Hirofumi, Kojika Masahiro, Suzuki Yasushi, Satoh Nobuhiro, Suzuki Kenji
Department of Anesthesiology , School of Medicine, Iwate Medical University, Morioka 020-8505.
Masui. 2006 Aug;55(8):1011-3.
A 55-year-old (163 cm, 70 kg) man with traumatic intra-abdominal bleeding underwent emergency operation. The patient was in a state of hemorrhagic shock with 82 mmHg of systolic blood pressure (SBP) at hospital arrival. His condition became severer within about 1 hr, and tracheal intubation and mechanical ventilation were consequently started in the ambulatory emergency room. SBP decreased to 60 mmHg when he was transferred to the operating room. Anesthesia was induced with intravenous fentanyl and vecuronium, and was maintained with inhalation of sevoflurane in 50% oxygen. After laparotomy, it was impossible to detect the bleeding source because of a large quantity of hemorrhage. To reduce the blood loss, aortic occlusion balloon catheter (AOBC) was inserted into the upper abdominal aorta via the right femoral artery. Aortic occlusion was performed twice each for twenty minutes. The evelation of SBP and decrease of bleeding dose were secured by aortic occlusion. Thereby the source of bleeding could be detected and surgical procedure could be finished with survival of the patient. The insertion of AOBC for the surgical patient with intra-abdominal hemorrhagic shock may be advantageous for uncontrollable bleeding.
一名55岁(身高163厘米,体重70千克)的男性因外伤性腹腔内出血接受了急诊手术。患者入院时处于失血性休克状态,收缩压(SBP)为82毫米汞柱。在大约1小时内他的病情变得更加严重,因此在门诊急诊室开始进行气管插管和机械通气。当他被转移到手术室时,收缩压降至60毫米汞柱。静脉注射芬太尼和维库溴铵诱导麻醉,并用50%氧气吸入七氟醚维持麻醉。剖腹手术后,由于大量出血无法检测到出血源。为了减少失血,通过右股动脉将主动脉阻断球囊导管(AOBC)插入上腹部主动脉。主动脉阻断分别进行了两次,每次20分钟。通过主动脉阻断确保了收缩压的升高和出血量的减少。从而能够检测到出血源,并且手术得以完成,患者存活。对于腹腔内出血性休克的手术患者插入AOBC可能对控制难以控制的出血有利。