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蛛网膜下腔神经轴阻滞下，尽管使用超声引导下的下腔静脉指标对患者进行了最佳预负荷，但仍发生心脏骤停：两例报告。

Cardiac arrest despite optimal preloading of patient using ultrasonography-guided inferior vena cava indices under subarachnoid neuraxial blockade: A report of two cases.

作者信息

Bhatnagar Vidhu, Dwivedi Deepak, Chakraborty Shatabdi, Ray Arijit

机构信息

Department of Neuroanaesthesia, Institute of Naval Medicine, INHS Asvini, Mumbai, Maharashtra, India.

Department of Anaesthesia, Institute of Naval Medicine, INHS Asvini, Mumbai, Maharashtra, India.

出版信息

Saudi J Anaesth. 2018 Jul-Sep;12(3):478-481. doi: 10.4103/sja.SJA_751_17.

DOI:10.4103/sja.SJA_751_17
PMID:30100853
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6044144/
Abstract

Spinal anesthesia (SA) is utilized as an effective means of anesthesia and has an impressive safety record but it is not devoid of complications, and sometimes, the complications are as fatal as cardiac arrest. Although many factors are involved in etiology of cardiac arrest under SA, the vagal responses to the decreased preload are the most common culprits. We report two cases of cardiac arrest under SA; which happened despite our patient being adequately preloaded utilizing the ultrasonography-guided targeted volume therapy. The patients were successfully resuscitated with no neurological deficit.

摘要

脊髓麻醉（SA）是一种有效的麻醉方法，具有令人印象深刻的安全记录，但并非没有并发症，有时并发症会像心脏骤停一样致命。虽然SA下心脏骤停的病因涉及许多因素，但迷走神经对前负荷降低的反应是最常见的原因。我们报告两例SA下心脏骤停的病例；尽管我们通过超声引导下的目标容量治疗对患者进行了充分的预负荷，但心脏骤停仍发生了。患者成功复苏，无神经功能缺损。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0bac/6044144/2c41af019fc1/SJA-12-478-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0bac/6044144/2e48350ed4c2/SJA-12-478-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0bac/6044144/2c41af019fc1/SJA-12-478-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0bac/6044144/2e48350ed4c2/SJA-12-478-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0bac/6044144/2c41af019fc1/SJA-12-478-g002.jpg

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本文引用的文献

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PROtocolized care to reduce HYpotension after spinal anaesthesia (ProCRHYSA randomized trial): Study protocol for a randomized controlled trial.脊髓麻醉后降低低血压的标准化护理（ProCRHYSA随机试验）：一项随机对照试验的研究方案
Contemp Clin Trials Commun. 2016 Jun 29;4:39-45. doi: 10.1016/j.conctc.2016.06.012. eCollection 2016 Dec 15.
2
Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients.下腔静脉可塌陷性可检测自主呼吸的危重症患者的液体反应性。
J Crit Care. 2017 Oct;41:130-137. doi: 10.1016/j.jcrc.2017.05.008. Epub 2017 May 12.
3
Assessing volume status and fluid responsiveness in the emergency department.
急诊科容量状态及液体反应性评估
Clin Exp Emerg Med. 2014 Dec 31;1(2):67-77. doi: 10.15441/ceem.14.040. eCollection 2014 Dec.
4
Effect of postural changes on inferior vena cava dimensions and its influence on haemodynamics during caesarean section under spinal anaesthesia.体位改变对下腔静脉尺寸的影响及其对腰麻下剖宫产术中血流动力学的影响。
J Obstet Gynaecol. 2015;35(7):667-71. doi: 10.3109/01443615.2014.991291. Epub 2014 Dec 29.
5
Cardiopulmonary arrest in spinal anesthesia.脊髓麻醉中的心肺骤停。
Rev Bras Anestesiol. 2011 Jan-Feb;61(1):110-20. doi: 10.1016/S0034-7094(11)70012-5.
6
Haemodynamic modifications after unilateral subarachnoid anaesthesia evaluated with transthoracic echocardiography.经胸超声心动图评估单侧蛛网膜下腔麻醉后的血流动力学改变。
Minerva Anestesiol. 2005 Mar;71(3):75-81.
7
Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effects of duration spent in the sitting position.老年患者腰麻使用0.5%重比重布比卡因：坐位停留时间的影响
Br J Anaesth. 2001 Nov;87(5):738-42. doi: 10.1093/bja/87.5.738.
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Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention.脊髓麻醉期间的心搏骤停：常见机制及预防策略
Anesth Analg. 2001 Jan;92(1):252-6. doi: 10.1097/00000539-200101000-00050.
9
[Is spinal anesthesia for operations in the prone or jackknife position suitable?].[俯卧位或折刀位手术的脊髓麻醉是否合适？]
Anaesthesist. 1999 Apr;48(4):242-50. doi: 10.1007/s001010050697.
10
Serious complications related to regional anesthesia: results of a prospective survey in France.与区域麻醉相关的严重并发症：法国一项前瞻性调查的结果
Anesthesiology. 1997 Sep;87(3):479-86. doi: 10.1097/00000542-199709000-00005.