硬膜外输注罗哌卡因致一度房室传导阻滞合并重症肌无力患者发生完全性房室传导阻滞：一例病例报告

Complete atrioventricular block under epidural ropivacaine infusion in a patient with first-degree atrioventricular block and myasthenia gravis: a case report.

作者信息

Hashimoto Takuma, Kuratomi Shinobu, Yoshimura Hayashi

机构信息

Department of Anesthesiology, Saiseikai Fukuoka General Hospital, Tenjin 1-3-46, Chuo-ku, Fukuoka-shi, Fukuoka-ken, 810-0001, Japan.

出版信息

JA Clin Rep. 2022 Apr 28;8(1):33. doi: 10.1186/s40981-022-00524-5.

DOI:10.1186/s40981-022-00524-5

PMID:35478063

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9046481/

Abstract

BACKGROUND

First-degree atrioventricular block (AVB) may lead to complete AVB. Herein, we present a case of a complete AVB under thoracic epidural catheter infusion of ropivacaine with fentanyl in a patient with first-degree AVB and myasthenia gravis.

CASE PRESENTATION

A 74-year-old woman with first-degree AVB underwent thymectomy for myasthenia gravis. Continuous thoracic epidural catheter infusion of 0.2% ropivacaine with fentanyl was initiated at 15 min before the end of the surgery. At 9 h postoperatively, the electrocardiogram showed a 10-s-long pause due to complete AVB. Thus, a temporary pacemaker was implanted, and at 19 h postoperatively on postoperative day 1, cardiac pacing was initiated and lasted approximately 30 s. After catheter removal, she had no further episodes of complete AVB.

CONCLUSION

First-degree AVB may lead to complete AVB under the influence of thoracic epidural infusion of ropivacaine in patients with myasthenia gravis.

摘要

背景

一度房室传导阻滞（AVB）可能会发展为完全性AVB。在此，我们报告一例患有一度AVB和重症肌无力的患者，在胸段硬膜外导管输注罗哌卡因加芬太尼期间发生完全性AVB的病例。

病例介绍

一名患有一度AVB的74岁女性因重症肌无力接受胸腺切除术。手术结束前15分钟开始持续胸段硬膜外导管输注0.2%罗哌卡因加芬太尼。术后9小时，心电图显示因完全性AVB出现长达10秒的停搏。因此，植入了临时起搏器，术后第1天术后19小时开始心脏起搏，持续约30秒。拔除导管后，她未再出现完全性AVB发作。