Tsuchihashi Kenji, Yoshihiro Tomoyasu, Aikawa Tomomi, Nio Kenta, Takayoshi Kotoe, Yokoyama Taku, Fukata Mitsuhiro, Arita Shuji, Ariyama Hiroshi, Shimizu Yukiko, Yoshida Yuichiro, Torisu Takehiro, Esaki Motohiro, Odashiro Keita, Kusaba Hitoshi, Akashi Koichi, Baba Eishi
Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences Department of Anesthesiology and Critical Care Medicine Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Medicine (Baltimore). 2017 Dec;96(49):e8987. doi: 10.1097/MD.0000000000008987.
Neurogenic shock is generally typified by spinal injury due to bone metastases in cancer patients, but continuous disturbance of the vagus nerve controlling the aortic arch baroreceptor can cause shock by a reflex response through the medulla oblongata.
A 43-year-old woman with dysphagia presented to our hospital. Computed tomography showed a primary tumor adjacent to and surrounding half the circumference of the descending aorta, and multiple cervical lymph node metastases, including a 55 × 35-mm lymph node overlapping the root of the left vagus nerve. Squamous esophageal cancer (T4bN3M1, stage IV) was diagnosed. Whereas shock status initially appeared soon after left cervical pain, suggesting pain-induced neutrally-mediated syncope, sustained bradycardia and hypotension occurred even after alleviation of pain by opioids.
Disturbance of the left vagus nerve associated with the aortic arch baroreceptor by a large left cervical lymph node metastasis was considered as the cause of shock, pathologically mimicking the baroreceptor reflex.
Systemic steroid administration was performed, and radiotherapy for both the primary site and lymph node metastasis was started 2 days after initiating steroid treatment.
Four days after initiating steroid administration, hypotension and bradycardia were improved and stable.
Disturbance of the vagus nerve controlling the aortic arch baroreceptor should be kept in mind as a potential cause of neurogenic shock in cancer patients, through a pathological reflex mimicking the baroreceptor reflex.
神经源性休克在癌症患者中通常以骨转移导致的脊髓损伤为典型表现，但控制主动脉弓压力感受器的迷走神经持续紊乱可通过延髓的反射反应引起休克。
一名43岁吞咽困难的女性前来我院就诊。计算机断层扫描显示，一个原发性肿瘤毗邻降主动脉并环绕其半周，且有多个颈部淋巴结转移，其中一个55×35毫米的淋巴结与左迷走神经根部重叠。诊断为食管鳞状细胞癌（T4bN3M1，IV期）。尽管左颈部疼痛后很快出现休克状态，提示疼痛诱导的神经介导性晕厥，但即使在使用阿片类药物缓解疼痛后，仍持续出现心动过缓和低血压。
左颈部巨大淋巴结转移导致与主动脉弓压力感受器相关的左迷走神经紊乱被认为是休克的原因，病理上类似于压力感受器反射。
进行了全身类固醇给药，并在开始类固醇治疗2天后对原发部位和淋巴结转移灶进行放疗。
开始使用类固醇4天后，低血压和心动过缓得到改善并稳定。
应牢记控制主动脉弓压力感受器的迷走神经紊乱是癌症患者神经源性休克的潜在原因，其通过模拟压力感受器反射的病理反射起作用。
