心脏结节病合并心脏再同步化治疗除颤器患者行腹腔镜辅助全直肠结肠切除术的麻醉管理：一例报告
Anesthetic management of laparoscopy-assisted total proctocolectomy in a cardiac sarcoidosis patient with a cardiac resynchronization therapy-defibrillator: a case report.
作者信息
Kammura Yutaro, Fujita Ai, Karashima Yuji, Nakayama Shoko, Shirozu Kazuhiro, Kandabashi Tadashi, Yamaura Ken
机构信息
Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan.
Operating Rooms, Kyushu University Hospital, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582, Japan.
出版信息
JA Clin Rep. 2020 Jun 6;6(1):43. doi: 10.1186/s40981-020-00350-7.
BACKGROUND
Cardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). For the first time, we report the anesthetic management of a CS patient with a CRT-D.
CASE PRESENTATION
A 65-year-old male with an implanted CRT-D due to CS was scheduled for a laparoscopy-assisted total proctocolectomy for his transverse colon cancer. His left ventricular ejection fraction was 32.0%, and his physical status was a New York Heart Association class III. General and epidural anesthesia were performed while using standard monitors and a FloTrac system. The dual-chamber pacing (DDD) modality of the CRT-D was unchanged, and its defibrillation function was deactivated before surgery. The surgery was successfully performed, and the patient was discharged without worsening of his cardiac condition.
CONCLUSIONS
A detailed understanding of this patient's condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient.
背景
心脏结节病（CS）可导致严重的传导异常和心律失常。越来越多的CS患者接受心脏再同步化治疗除颤器（CRT-D）治疗。我们首次报告了一名植入CRT-D的CS患者的麻醉管理情况。
病例介绍
一名因CS植入CRT-D的65岁男性，计划接受腹腔镜辅助全直肠结肠切除术以治疗横结肠癌。他的左心室射血分数为32.0%，身体状况为纽约心脏协会III级。在使用标准监测仪和FloTrac系统的同时实施了全身麻醉和硬膜外麻醉。CRT-D的双腔起搏（DDD）模式未改变，其除颤功能在手术前停用。手术成功完成，患者出院时心脏状况未恶化。
结论
对该患者病情以及结节病的详细了解有助于成功实施该患者的麻醉管理。
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