Ozaki S, Sugiura Y, Ozeki Y, Okuda E, Yoshizu H, Shima S, Tanaka S, Suzuki M
2nd Department of Surgery, National Defence Medical College.
Kokyu To Junkan. 1990 Mar;38(3):265-8.
A 47-year-old man with advanced pancreatic carcinoma underwent total pancreatectomy with resection of the involved portal vein. His postoperative course was complicated by a couple of cardiac arrest episodes. The first episode occurred seven weeks after surgery during drip infusion of CDDP, and later on during the thirteenth week after surgery. There was no apparent cause for those episodes. On both occasions resuscitation was performed adequately. The second arrest was followed by deep inverted T waves on ECG, however, not by elevation of serum CPK-MB. Because of this, myocardial infarction was ruled out. The diagnosis of cardiomyopathy was made possible through the discovery on the echocardiogram of a hypertrophied left ventricle with thick interventricular septum. Then, on catheterization, myocardial squeezing in the left anterior descending coronary artery was noticed. Finally, histological findings concerning the biopsied cardiac muscle led to the same diagnosis. Cardiac arrest in this case seemed to be due to arrhythmia caused by cardiomyopathy. Echo cardiography should be routinely used as part of the examination prior to extended major surgery.
一名47岁的晚期胰腺癌男性患者接受了全胰切除术，并切除了受累的门静脉。他的术后病程因几次心脏骤停事件而复杂化。第一次事件发生在术后七周，当时正在滴注顺铂，后来在术后第十三周又发生了一次。这些事件没有明显原因。两次事件均进行了充分的复苏。第二次心脏骤停后，心电图上出现了深倒置T波，但血清肌酸磷酸激酶同工酶（CPK-MB）没有升高。因此，排除了心肌梗死。通过超声心动图发现左心室肥厚且室间隔增厚，从而确诊为心肌病。然后，在导管检查中，注意到左前降支冠状动脉的心肌挤压。最后，活检心肌的组织学结果也得出了相同的诊断。该病例中的心脏骤停似乎是由心肌病引起的心律失常所致。在进行扩大的大手术之前，应常规使用超声心动图作为检查的一部分。
