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使用丙泊酚时发生结下心脏传导阻滞和心源性休克的可能性。

Potential for Infra-Nodal Heart Block and Cardiogenic Shock With Propofol Administration.

作者信息

Olson Nicholas, Lim Michael J, Ferreira Scott W, Mehdirad Ali A

机构信息

Saint Louis University, Department of Cardiology, 3635 Vista Avenue, Saint Louis, MO, 63110-0250, 13th floor Desloge Tower, 63110-0250, USA.

出版信息

Cardiol Res. 2013 Feb;4(1):35-40. doi: 10.4021/cr252w. Epub 2013 Mar 8.

DOI:10.4021/cr252w
PMID:28348701
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5358186/
Abstract

We report a case of infra-nodal complete heart block and cardiogenic shock in a previously healthy 64-year-old man after administration of 180 mg of intravenous Propofol. Although bradycardia, hypotension, and heart block are commonly seen with propofol administration, such findings are transient and respond quickly to administration of vagolytic or sympathomimetic agents suggesting an AV nodal mechanism of heart block. Sustained left ventricular systolic dysfunction and cardiogenic shock by an alternative, non-autonomic mechanism has also been described in the setting of Propofol administration. Our case is the first to note sustained complete infra-nodal heart block in this setting. Early recognition of such a complication, restoration of atrio-ventricular (A-V) synchrony with dual chamber pacing, and aggressive circulatory support is essential in bridging such patients to recovery.

摘要

我们报告一例64岁既往健康男性在静脉注射180毫克丙泊酚后出现结下完全性心脏传导阻滞和心源性休克的病例。虽然丙泊酚给药时常见心动过缓、低血压和心脏传导阻滞，但这些表现是短暂的，对使用抗迷走神经或拟交感神经药物反应迅速，提示心脏传导阻滞的房室结机制。在丙泊酚给药情况下，也有通过另一种非自主机制导致的持续性左心室收缩功能障碍和心源性休克的描述。我们的病例是首次注意到在这种情况下出现持续性结下完全性心脏传导阻滞。早期识别这种并发症、通过双腔起搏恢复房室（A-V）同步以及积极的循环支持对于帮助此类患者康复至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/3ea9a5adab97/cr-04-035-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/0a06706b3649/cr-04-035-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/31e9f07ac579/cr-04-035-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/31334559df31/cr-04-035-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/461de21f36a7/cr-04-035-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/3ea9a5adab97/cr-04-035-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/0a06706b3649/cr-04-035-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/31e9f07ac579/cr-04-035-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/31334559df31/cr-04-035-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/461de21f36a7/cr-04-035-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e82/5358186/3ea9a5adab97/cr-04-035-g005.jpg

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本文引用的文献

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Cardiogenic shock following administration of propofol and fentanyl in a healthy woman: a case report.一名健康女性在使用丙泊酚和芬太尼后发生心源性休克：病例报告
J Med Case Rep. 2011;5:382. doi: 10.1186/1752-1947-5-382. Epub 2011 Aug 16.
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Transient acute decompensated heart failure following propofol and fentanyl administration in a healthy 19-year-old patient.一名19岁健康患者在使用丙泊酚和芬太尼后出现短暂性急性失代偿性心力衰竭。
Congest Heart Fail. 2010 Mar-Apr;16(2):80-1. doi: 10.1111/j.1751-7133.2009.00125.x.
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Propofol infusion syndrome.
丙泊酚输注综合征
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Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans.丙泊酚对人体进行中度和深度镇静时的交感神经及血流动力学效应
Anesthesiology. 2005 Jul;103(1):20-4. doi: 10.1097/00000542-200507000-00007.
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Clinical management of cardiogenic shock associated with prolonged propofol infusion.与长时间输注丙泊酚相关的心源性休克的临床管理。
Anesth Analg. 2004 Jul;99(1):221-226. doi: 10.1213/01.ANE.0000117285.12600.C1.
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The effects of propofol on the contractility of failing and nonfailing human heart muscles.丙泊酚对衰竭和非衰竭人体心肌收缩力的影响。
Anesth Analg. 2001 Sep;93(3):550-9. doi: 10.1097/00000539-200109000-00006.
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Crit Care Med. 1998 Dec;26(12):2087-92. doi: 10.1097/00003246-199812000-00046.
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Mechanisms whereby propofol mediates peripheral vasodilation in humans. Sympathoinhibition or direct vascular relaxation?丙泊酚介导人体外周血管舒张的机制。是交感神经抑制还是直接血管舒张？
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Anesth Analg. 1993 Oct;77(4 Suppl):S21-9.