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[福山型先天性肌营养不良患者脊柱侧弯手术的全静脉麻醉]

[Total intravenous anesthesia for a patient with Fukuyama congenital muscular dystrophy undergoing scoliosis surgery].

作者信息

Matsuda Hiromi, Arai Masayasu, Okamoto Hirotsugu

出版信息

Masui. 2014 Jun;63(6):650-3.

PMID:24979856
Abstract

We described the anesthetic management of a 17-year-old male patient with Fukuyama congenital muscle dystrophy (FCMD) who underwent surgical repair for scoliosis under total intravenous anesthesia. The patient had severe constructive lung disease (%VC 18.6%). Left ventricular wall motion was reduced (left ventricular ejection fraction 40%). Propofol and remifentanil were continuously infused to maintain anesthesia, but we did not use any muscle relaxant throughout the course. We used arterial pressure-based cardiac output and stroke volume variation as a guide for circulatory management. We could not find any congestion on chest X-ray after the surgery. The emergence and recovery from the anesthesia was rapid and muscle strength was enough, and we could extubate the patient just after the end of the surgery. No respiratory and cardiac complications occurred during the postoperative period. Even though he was in the young age in FCMD, respiratory and cardiac complications were severely impaired. For successful anesthetic management in FCMD patient, we should take care of rapid emergence from anesthesia and also we should not impair muscle strength for good postoperative respiratory function. Appropriate hemodynamic monitoring to avoid postoperative cardiac congestion is also required.

摘要

我们描述了一名17岁福山型先天性肌营养不良(FCMD)男性患者在全静脉麻醉下接受脊柱侧弯手术修复时的麻醉管理情况。该患者患有严重的阻塞性肺病(肺活量百分比为18.6%)。左心室壁运动减弱(左心室射血分数为40%)。持续输注丙泊酚和瑞芬太尼以维持麻醉,但在整个过程中未使用任何肌肉松弛剂。我们使用基于动脉压的心输出量和每搏量变异作为循环管理的指导。术后胸部X线检查未发现任何充血情况。麻醉苏醒迅速,肌肉力量充足,手术结束后即可拔除患者气管导管。术后期间未发生呼吸和心脏并发症。尽管该患者处于FCMD的年轻年龄段,但呼吸和心脏功能严重受损。对于FCMD患者的成功麻醉管理,我们应注意麻醉的快速苏醒,同时不应损害肌肉力量以确保良好的术后呼吸功能。还需要进行适当的血流动力学监测以避免术后心脏充血。

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