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直肠腹会阴联合切除术（迈尔斯手术）期间发生肛门-心脏反射导致冠状动脉痉挛和心脏骤停：病例报告及文献复习

Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature.

作者信息

Lin Yimei, Wu Jingyi, Wu Junmei, Liu Juanlan, Liang Chao

机构信息

Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China.

Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180# Feng-Lin Road, Shanghai, China.

出版信息

J Cardiothorac Surg. 2025 Mar 26;20(1):165. doi: 10.1186/s13019-025-03387-w.

DOI:10.1186/s13019-025-03387-w
PMID:40140877
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11938595/
Abstract

BACKGROUND

Coronary artery spasm (CAS) has been frequently documented during regional or general anesthesia. However, severe cardiac arrest induced by CAS as a result of anal-cardiac and vasovagal reflexes is relatively uncommon.

CASE PRESENTATION

This report describes a patient with a history of CAS and percutaneous coronary angioplasty (PTCA) who experienced coronary artery spasm and subsequent cardiac arrest during anal anastomosis in a transabdominal perineal radical resection of rectal cancer (MILES procedure).

CONCLUSION

This case study offers significant insights into the pathophysiology of cardiac arrest induced by surgical intervention in the anal region, which is densely innervated by the vagus nerve at the terminal portion of the rectum. This phenomenon may be associated with the anal cardiac reflex and vagus nerve reflexes. It is imperative to recognize the potential for catastrophic outcomes due to vagus nerve excitation during rectal end surgery, particularly in patients with a history of acute CAS.

摘要

背景

冠状动脉痉挛（CAS）在区域麻醉或全身麻醉期间经常有记录。然而，由肛门 - 心脏和血管迷走反射导致的CAS引起的严重心脏骤停相对少见。

病例介绍

本报告描述了一名有CAS和经皮冠状动脉腔内血管成形术（PTCA）病史的患者，在直肠癌经腹会阴根治性切除术（Miles手术）的肛门吻合术中发生冠状动脉痉挛并随后心脏骤停。

结论

本病例研究为肛门区域手术干预引起心脏骤停的病理生理学提供了重要见解，直肠末端由迷走神经密集支配。这种现象可能与肛门心脏反射和迷走神经反射有关。在直肠末端手术期间，认识到迷走神经兴奋导致灾难性后果的可能性至关重要，特别是对于有急性CAS病史的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/618d/11938595/f400d45d760a/13019_2025_3387_Fig6_HTML.jpg
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Coronary Artery Spasm: New Insights.冠状动脉痉挛：新的认识。
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Vagus Nerve Stimulation and the Cardiovascular System.迷走神经刺激与心血管系统。
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Cardiac Arrest in the Operating Room: Part 2-Special Situations in the Perioperative Period.手术室心搏骤停：第二部分-围术期特殊情况。
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