病例报告：经鼻蝶窦内镜垂体手术前鼻腔消毒时引发 rhino-cardiac 反射导致 2 例心跳骤停。
Case report: 2 cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting nasal cavity before endonasal transsphenoidal endoscopic pituitary surgery.
机构信息
Department of Anaesthesiology, Xiangya Hospital Central South University, Changsha, 410008, Hunan, China.
出版信息
BMC Anesthesiol. 2021 Jan 13;21(1):18. doi: 10.1186/s12871-021-01240-w.
BACKGROUND
Trigeminal-cardiac reflex (TCR) is a brainstem vagus reflex that occurs when any center or peripheral branch of the trigeminal nerve was stimulated or operated on. The typical clinical manifestation is sudden bradycardia with or without blood pressure decline. The rhino-cardiac reflex which is one type of TCR is rare in clinical practice. As the rhino-cardiac reflex caused by disinfection of the nasal cavity is very rare, we report these two cases to remind other anesthesiologists to be vigilant to this situation.
CASE PRESENTATION
This case report describes two cases of cardiac arrest caused by rhino-cardiac reflex while disinfecting nasal cavity before endoscopic transsphenoidal removal of pituitary adenomas. Their heart rate all dropped suddenly at the very moment of nasal stimulation and recovered quickly after stimulation was stopped and the administration of drugs or cardiac support.
CONCLUSION
Although the occurrence of rhino-cardiac reflex is rare, we should pay attention to it in clinical anesthesia. It is necessary to know the risk factors for preventing it. Once it occurs, we should take active and effective rescue measures to avoid serious complications.
背景
三叉神经-心脏反射（TCR）是一种脑干迷走反射，当三叉神经的任何中枢或外周分支受到刺激或手术时就会发生。典型的临床表现是突然出现心动过缓伴或不伴血压下降。作为 TCR 的一种，鼻心反射在临床上较为罕见。由于鼻腔消毒引起的鼻心反射非常罕见，我们报告这两例病例，以提醒其他麻醉医生对此情况保持警惕。
病例介绍
本病例报告描述了两例在经蝶窦切除垂体瘤前鼻腔消毒时因鼻心反射引起的心脏骤停的病例。他们的心率在鼻腔受到刺激的那一刻都突然下降，并在刺激停止和给予药物或心脏支持后迅速恢复。
结论
尽管鼻心反射的发生较为罕见，但在临床麻醉中仍应予以重视。有必要了解其预防的危险因素。一旦发生，应采取积极有效的抢救措施，避免严重并发症。
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