Im Hyeongwoo, Min Jeong Jin, Yang Jaeyoung, Lee Sangmin Maria, Lee Jong Hwan
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2015 Dec;68(6):608-12. doi: 10.4097/kjae.2015.68.6.608. Epub 2015 Nov 25.
Polycythemia vera is a chronic progressive myeloproliferative disease characterized by increased circulating red blood cells, and the hyperviscosity of the blood can lead to an increased risk of arterial thrombosis. In a previous survey regarding postoperative outcomes in polycythemia vera patients, an increased risk of both vascular occlusive and hemorrhagic complications have been reported. Aortic surgery involving cardiopulmonary bypass may be associated with the development of a coagulopathy, and as a result, the occurrence of thrombotic complications should be avoided after coronary anastomosis. Thus, optimizing the hemostatic balance is an important concern for anesthesiologists. However, only a few cases of anesthetic management in polycythemia vera patients undergoing concomitant aorta and coronary arterial bypass surgery have ever been reported. Here, we experience a polycythemia vera patient who underwent an emergency repair of a type-A aortic dissection and concomitant coronary artery bypass grafting, and report this case with a review of the relevant literature.
真性红细胞增多症是一种慢性进行性骨髓增殖性疾病，其特征为循环红细胞增多，血液高黏滞性可导致动脉血栓形成风险增加。在之前一项关于真性红细胞增多症患者术后结局的调查中，已报告血管闭塞性和出血性并发症的风险均增加。涉及体外循环的主动脉手术可能与凝血病的发生有关，因此，冠状动脉吻合术后应避免血栓形成并发症的发生。因此，优化止血平衡是麻醉医生的一个重要关注点。然而，仅有少数关于真性红细胞增多症患者同期行主动脉和冠状动脉搭桥手术的麻醉管理病例报道。在此，我们诊治了一名接受A型主动脉夹层急诊修复术并同期行冠状动脉搭桥术的真性红细胞增多症患者，并结合相关文献对该病例进行报告。
