Harioka T, Miyake C, Toda H, Sone T, Yamanaka K
Masui. 1989 Jun;38(6):801-4.
A 57-year-old man with Shy-Drager syndrome underwent plastic surgery for decubitus on the buttocks under general anesthesia. Before induction of anesthesia, an elastic bandage was applied to the legs, and its effects were examined by raising the upper body. The fall in mean blood pressure decreased from 49% to 39%, and the symptoms of cerebral hypoxia disappeared. However, the induction of anesthesia with 5 mg diazepam, 0.05 mg fentanyl, and 100 mg thiamylal reduced blood pressure abruptly from 150/88 mmHg to 95/68 mmHg. Continuous infusion of phenylephrine was then started, and blood pressure became stable at around 150/90 mmHg. In this state, IPPV did not reduce the blood pressure in the supine position, and did not intensify its fall when the upper body was raised. Anesthesia was maintained with nitrous oxide 70% in oxygen, fentanyl and pancuronium. During the surgery, ventilation was controlled, and phenylephrine was infused at the rate of 5-15 micrograms.min-1 to maintain systolic blood pressure above 100 mmHg. Phenylephrine was infused during the two postoperative days, because blood pressure fell whenever the patient's posture was changed to prevent pressure on the operative site.
一名患有Shy-Drager综合征的57岁男性在全身麻醉下接受了臀部褥疮整形手术。麻醉诱导前，在其腿部绑扎弹力绷带，并通过抬高上身来检查其效果。平均血压下降幅度从49%降至39%，脑缺氧症状消失。然而，使用5毫克地西泮、0.05毫克芬太尼和100毫克硫喷妥钠进行麻醉诱导后，血压从150/88毫米汞柱突然降至95/68毫米汞柱。随后开始持续输注去氧肾上腺素，血压稳定在150/90毫米汞柱左右。在此状态下，间歇正压通气（IPPV）在仰卧位时未降低血压，在上身抬高时也未加剧血压下降。麻醉维持采用70%氧化亚氮、氧气、芬太尼和潘库溴铵。手术期间，控制通气，并以5 - 15微克·分钟⁻¹的速率输注去氧肾上腺素，以维持收缩压高于100毫米汞柱。术后两天持续输注去氧肾上腺素，因为每当患者改变体位时血压都会下降，以防止对手术部位造成压迫。
