Chung Kyudon, Bang Seunguk, Kim Yoona, Chang Hyuntae
Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon, 301-723, Republic of Korea.
J Anesth. 2016 Feb;30(1):148-51. doi: 10.1007/s00540-015-2070-4. Epub 2015 Sep 2.
We present the first reported case of a patient with intraoperative hypoglycemia, with no predisposing factors, that was indicative of post-hepatectomy liver failure due to liver injury. A 56-year-old man was hospitalized to undergo left lateral segmentectomy, cholecystectomy and T-tube choledocholithotripsy due to calculi in the intrahepatic and common bile ducts. His medical history was unremarkable. Three hours after surgery initiation, his glucose level decreased from 84 mg/dL to below detectable levels. We infused 20 % dextrose repeatedly until his glucose level returned to within normal limits. His aspartate aminotransferase and alanine aminotransferase levels increased to over 10,000 IU/L, and his blood urea nitrogen and creatinine levels increased postoperatively. Thus, we diagnosed post-hepatectomy liver failure and hepatorenal syndrome and treated the patient conservatively. This case illustrates that, if no other causative factors for severe hypoglycemia occurring during liver resection are present, the anesthesiologist should predict post-hepatectomy liver failure due to liver injury and inform the surgeon in order to enable rapid evaluation and treatment.
我们报告了首例无诱发因素的术中低血糖患者病例，该病例提示因肝损伤导致肝切除术后肝衰竭。一名56岁男性因肝内胆管和胆总管结石入院接受左外叶肝切除术、胆囊切除术及T管胆管取石术。他的病史无特殊。手术开始三小时后，其血糖水平从84mg/dL降至检测不到的水平以下。我们反复输注20%葡萄糖，直至其血糖水平恢复正常范围。其天冬氨酸转氨酶和丙氨酸转氨酶水平升至超过10,000IU/L，术后血尿素氮和肌酐水平升高。因此，我们诊断为肝切除术后肝衰竭和肝肾综合征，并对患者进行了保守治疗。该病例表明，如果肝切除术中发生严重低血糖不存在其他致病因素，麻醉医生应预测因肝损伤导致的肝切除术后肝衰竭，并告知外科医生以便能迅速进行评估和治疗。
