Amano N, Matsuki A, Oyama T, Satoh Y
Masui. 1989 Sep;38(9):1201-5.
A 54 year-old man with congestive cardiomyopathy underwent total cystectomy with formation of ileal conduit under fentanyl anesthesia. Preoperative status was evaluated to be very risky with ASA 3, Goldman cardiac risk index 28 and NYHA 3. Cardiac function was evaluated with Swan-Ganz catheter during anesthesia with fentanyl (30 mcg.kg-1) and 60% nitrous oxide. Dopamine, dobutamine and vasodilators (prostaglandin E1, trinitroglycerin) were continuously infused intravenously to decrease high afterload and enhance diminished cardiac contractility. On the 7th post-operative day, massive atelectasis in the right lung was observed, which was improved by positive pressure ventilation and vigorous bronchial lavage. A careful management with meticulous anesthetic care is emphasized for patients with congestive cardiomyopathy.
一名54岁充血性心肌病男性患者在芬太尼麻醉下接受了全膀胱切除术并建立回肠膀胱术。术前评估其病情风险极高，美国麻醉医师协会（ASA）分级为3级， Goldman心脏风险指数为28，纽约心脏协会（NYHA）心功能分级为3级。在使用芬太尼（30 mcg.kg-1）和60%氧化亚氮进行麻醉期间，通过 Swan-Ganz 导管评估心脏功能。持续静脉输注多巴胺、多巴酚丁胺和血管扩张剂（前列腺素E1、硝酸甘油）以降低高后负荷并增强减弱的心脏收缩力。术后第7天，观察到右肺出现大面积肺不张，通过正压通气和积极的支气管灌洗得以改善。强调对充血性心肌病患者要进行精心的麻醉护理和细致的管理。
