Yoshioka Masatomo, Matsushita Sachiko, Nunokawa Hiroko, Yamakawa Mikiko, Kagami Isao
Department of Anesthesiology, Yamagata Prefectual Central Hospital, Yamagata.
Masui. 2008 Nov;57(11):1435-8.
We report a case of cerebral infarction developed either during or immediately after an operation. A 71-year-old man with esophageal cancer and a history of hypertension and asymptomatic cerebral infarction underwent right thoracolaparotomy for a subtotal esophagectomy. Anesthesia was maintained with a combination of 2% sevoflurane in oxygen and epidural analgesia using 2% mepivacaine. The operation was uneventful and the patient was transferred to ICU with the tracheal tube in place. On removal of the tracheal tube the next day the patient was unable to speak and his grip power of the right hand was weak. On CT a cerebral infarction was found in the left frontal lobe. A left carotid echogram showed a 90% constriction. The occlusion of the middle cerebral artery by an embolus detached from the constricted origin of the carotid artery was thought a most probable cause of the cerebral infarction. The presence of a carotid constriction must be explored preoperatively in aged patients scheduled to undergo extensive manipulations in the neck
我们报告一例在手术期间或手术后即刻发生脑梗死的病例。一名71岁男性，患有食管癌，有高血压病史及无症状脑梗死史，因次全食管切除术接受了右胸腹部联合切开术。采用2%七氟醚与氧气混合并使用2%甲哌卡因进行硬膜外镇痛维持麻醉。手术过程顺利，患者带气管导管转入重症监护病房。次日拔除气管导管时，患者不能说话，右手握力减弱。CT检查发现左额叶有脑梗死。左侧颈动脉超声检查显示有90%的狭窄。来自颈动脉狭窄起始处脱落的栓子阻塞大脑中动脉被认为是脑梗死最可能的原因。对于计划在颈部进行广泛操作的老年患者，术前必须探查是否存在颈动脉狭窄。
