Ye Yuancai, Wang Weisi, Yang Lei, He Min
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu City, Sichuan, People's Republic of China.
Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu City, Sichuan, People's Republic of China.
Int Med Case Rep J. 2023 Jun 1;16:333-337. doi: 10.2147/IMCRJ.S409578. eCollection 2023.
A 56-year-old female patient was admitted to the hospital for "10+days of right eye droop and 1 day of aggravation". After admission, the physical examination found that the patient had severe scoliosis. 3D reconstruction and enhanced CT scan of the head vessels showed that the right internal carotid artery C6 aneurysms were clipped under general anesthesia. After the operation, the patient had increased airway pressure, with a large number of pink foam sputum attracted from the trachea catheter, and the lungs were scattered with moist rales during auscultation, After the treatment of anti-heart failure, the patient returned to the ICU through the trachea catheter. Eight hours later, the trachea catheter was pulled out and the patient was released from the ventilator. The symptoms were relieved on the fifth day after the operation. This case report describes the perioperative management of intracranial aneurysm with severe scoliosis. After strict monitoring and timely treatment during the perioperative period, the patient turned from crisis to safety, providing some reference for colleagues who encounter such patients in the future.
In patients with scoliosis, due to long-term compression of the thorax, pulmonary restrictive ventilation dysfunction, small airway function and diffusion function are reduced, and cardiac function is decreased. Therefore, during the operation of intracranial aneurysms, fluid infusion should be careful, and volume monitoring should be done at all times to maintain the effective circulating blood volume of the body and prevent the aggravation of cardiac insufficiency and pulmonary edema.
一名56岁女性患者因“右眼下垂10余天,加重1天”入院。入院后体格检查发现患者有严重脊柱侧弯。头颅血管3D重建及增强CT扫描显示右侧颈内动脉C6段动脉瘤,在全身麻醉下行夹闭术。术后患者气道压力升高,气管导管吸出大量粉红色泡沫痰,听诊双肺散在湿啰音,经抗心力衰竭治疗后,患者经气管导管返回重症监护病房。8小时后拔除气管导管,脱离呼吸机。术后第5天症状缓解。本病例报告描述了伴有严重脊柱侧弯的颅内动脉瘤围手术期管理。经过围手术期严格监测和及时治疗,患者转危为安,为今后遇到此类患者的同行提供了一些参考。
脊柱侧弯患者由于胸廓长期受压,肺限制性通气功能障碍,小气道功能及弥散功能降低,心功能下降。因此,在颅内动脉瘤手术过程中,应谨慎输液,随时进行容量监测,以维持机体有效循环血容量,防止心功能不全及肺水肿加重。