Gregory Stephen H, Fierro Michael A
Department of Anesthesiology, Duke University Medical Center, DUMC 3094, Durham, NC, 27710, USA.
J Clin Anesth. 2016 Nov;34:124-7. doi: 10.1016/j.jclinane.2016.03.028. Epub 2016 May 3.
Hypertrophic cardiomyopathy (HCM) presents a significant perioperative challenge. Anesthetic drugs, patient positioning, and surgical technique can provoke worsening left ventricular outflow tract obstruction and hemodynamic deterioration. In this case report, we present the perioperative management of a 70-year-old male with a history of HCM who underwent a robotic laparoscopic prostatectomy. Discussion focuses on the utilization of echocardiographic guidance in the care of patients with HCM undergoing noncardiac surgery, as well as the pathophysiology of laparoscopic insufflation and its effects on left ventricular outflow tract obstruction in HCM.
肥厚型心肌病(HCM)给围手术期带来了重大挑战。麻醉药物、患者体位和手术技术都可能引发左心室流出道梗阻加重和血流动力学恶化。在本病例报告中,我们介绍了一名有HCM病史的70岁男性患者接受机器人辅助腹腔镜前列腺切除术的围手术期管理。讨论重点在于超声心动图引导在患有HCM的非心脏手术患者护理中的应用,以及腹腔镜充气的病理生理学及其对HCM患者左心室流出道梗阻的影响。