成功治疗一名与肾母细胞瘤相关的高血压性心力衰竭婴儿：病例报告

Successful management of an infant with hypertensive heart failure associated with Wilms' tumor: a case report.

作者信息

Miura Hiroko, Kawana Shin, Sugino Shigekazu, Kikuchi Chika, Yamauchi Masanori

机构信息

Department of Anesthesia, Miyagi Children's Hospital, 3-17, Ochiai 4, Aoba-ku, Sendai, Miyagi, 989-3126, Japan.

Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.

出版信息

JA Clin Rep. 2020 Feb 13;6(1):12. doi: 10.1186/s40981-020-00318-7.

DOI:10.1186/s40981-020-00318-7

PMID:32056027

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7018917/

Abstract

BACKGROUND

Wilms' tumor with hyperreninemia may result in critical cardiovascular decompensation. We report a case of severe hypertensive heart failure followed by tumor resection in a 3-month-old infant with Wilms' tumor.

CASE PRESENTATION

A 3-month-old girl was admitted to the intensive care unit for Wilms' tumor with hypertension and hypoxia. Her systolic blood pressure was 110 mmHg, and her SpO was 92%. She presented with severe hypertensive heart failure and received mechanical ventilation and antihypertensive therapy for hypertension and heart failure. An alpha 2-adrenergic receptor agonist was used for sedation as part of her antihypertensive therapy. On hospital day 16, nephrectomy with tumor resection was performed under general anesthesia. Her systolic blood pressure did not vary more than 20 mmHg during surgery due to appropriate preoperative management. Hemodynamic collapse did not occur.

CONCLUSIONS

The highlight of this case report is the successful management of an infant with Wilms' tumor, particularly with respect to preoperative hemodynamic control and sedation.

摘要

背景

伴有高肾素血症的肾母细胞瘤可能导致严重的心血管代偿失调。我们报告一例3个月大患有肾母细胞瘤的婴儿，出现严重高血压性心力衰竭，随后进行了肿瘤切除术。

病例介绍

一名3个月大的女孩因患有高血压和缺氧的肾母细胞瘤入住重症监护病房。她的收缩压为110mmHg，血氧饱和度为92%。她表现为严重的高血压性心力衰竭，并接受了机械通气以及针对高血压和心力衰竭的抗高血压治疗。作为抗高血压治疗的一部分，使用了一种α2肾上腺素能受体激动剂进行镇静。在住院第16天，在全身麻醉下进行了肾切除术及肿瘤切除术。由于术前管理得当，术中她的收缩压波动不超过20mmHg。未发生血流动力学崩溃。