Ishigaki Maiko, Hoshi Takuo, Tanaka Makoto
Department of Anesthesiology, Tsukuba University Hospital, Tsukuba 305-8575.
Masui. 2009 Nov;58(11):1433-6.
We experienced a case of coronary artery spasm during one-lung ventilation. A 66-year-old man was scheduled for right upper lobectomy for lung cancer. He had a history of hypertension and cerebral infarction, but without any history or evidence of ischemic heart disease. After induction of general anesthesia, a left-sided double lumen tube was inserted. The patient was placed in the left lateral position, and one lung ventilation was started. Before skin incision, we noticed marked ST elevation on the ECG monitor, after which continuous infusion of nitroglycerin and two lung ventilation were initiated. In several minutes, ST elevation subsided completely. We cancelled the surgery and performed the coronary angiography, which demonstrated normal coronary arteries. A diagnosis of coronary artery spasm was made. Possible triggering factors for coronary artery spasm in this case were considered to be an increase in right ventricular pressure due to one-lung ventilation, and vagal stimulation associated with remifentanil use. The importance of evaluation of preoperative risk factors, avoidance of triggering factors and perioperative treatments are emphasized to prevent the coronary artery spasm.
我们遇到了一例单肺通气期间发生冠状动脉痉挛的病例。一名66岁男性计划因肺癌行右上叶切除术。他有高血压和脑梗死病史，但无缺血性心脏病史或证据。全身麻醉诱导后，插入左侧双腔气管导管。患者置于左侧卧位，开始单肺通气。在皮肤切开前，我们在心电图监测仪上注意到明显的ST段抬高，随后开始持续输注硝酸甘油并进行双肺通气。几分钟后，ST段抬高完全消退。我们取消了手术并进行了冠状动脉造影，结果显示冠状动脉正常。诊断为冠状动脉痉挛。该病例中冠状动脉痉挛的可能触发因素被认为是单肺通气导致右心室压力增加，以及与瑞芬太尼使用相关的迷走神经刺激。强调术前评估危险因素、避免触发因素和围手术期治疗对预防冠状动脉痉挛的重要性。
