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青少年特发性脊柱侧弯手术后心力衰竭的成功体外膜肺氧合治疗。

Successful extracorporeal membrane oxygenation for heart failure after adolescent idiopathic scoliosis surgery.

作者信息

Wu Po-Ju, Chiang Wen-Po, Fu Chun-Wei, Chang Ting-Kuo

机构信息

Department of Orthopedic, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, Taiwan.

Department of Medicine, Mackay Medical College, Taipei, Taiwan.

出版信息

Eur Spine J. 2025 Mar;34(3):918-924. doi: 10.1007/s00586-025-08666-7. Epub 2025 Jan 22.

Abstract

PURPOSE

Spine surgery, particularly deformity correction, is associated with a high risk of peri-operative or post-operative complications, and these complications can lead to catastrophic consequences. This case report will present the etiology and treatment process of the peri-operative cardiac arrest during scoliosis correction surgery.

METHOD

In this report, we present a case of cardiac arrest during posterior correction surgery in a 17-year-old female patient with adolescent idiopathic scoliosis.

RESULTS

The patient was successfully treated using extracorporeal membrane oxygenation and an intra-aortic balloon pump. We have discussed the potential causes of peri-operative cardiac arrest, including thromboembolism (VAE/PE), electrolyte imbalance (Hyper/Hypokalemia or Acidosis), hypovolemia, hypothermia, and cardiogenic shock related to neurogenic-stunned myocardium.

CONCLUSION

There are many etiologies should be considered in peri-operative cardiac arrest during posterior correction spine surgery, such as venous air embolism and electrolyte imbalance. Stress cardiomyopathy, which occurs after stressful conditions, such as surgery should also be considered. Surgeons must consider these etiologies when faced with critical situations, and the successful treatment of such cases relies on team collaboration and prompt intervention.

摘要

目的

脊柱手术,尤其是畸形矫正手术,与围手术期或术后并发症的高风险相关,且这些并发症可能导致灾难性后果。本病例报告将呈现脊柱侧弯矫正手术期间围手术期心脏骤停的病因及治疗过程。

方法

在本报告中,我们呈现了一例17岁青少年特发性脊柱侧弯女性患者在后路矫正手术期间发生心脏骤停的病例。

结果

该患者通过体外膜肺氧合和主动脉内球囊泵成功得到治疗。我们讨论了围手术期心脏骤停的潜在原因,包括血栓栓塞(静脉空气栓塞/肺栓塞)、电解质失衡(高钾血症/低钾血症或酸中毒)、低血容量、体温过低以及与神经源性心肌顿抑相关的心源性休克。

结论

后路矫正脊柱手术期间围手术期心脏骤停应考虑多种病因,如静脉空气栓塞和电解质失衡。应激性心肌病也应予以考虑,其发生在诸如手术等应激状态之后。外科医生在面对危急情况时必须考虑这些病因,而此类病例的成功治疗依赖于团队协作和及时干预。

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