Pavoni V, Capuzzo M, Righini E, Gritti G
Istituto di Anestesiologia e Rianimazione, Università degli Studi di Ferrara.
Minerva Anestesiol. 1994 Sep;60(9):467-71.
We report a case of protracted intraoperative cardiac arrest (15 minutes), occurring in a patient with haemorrhagic shock in consequence of a bullet wound to the right hemithorax; external cardiac massage was immediately started and carried on until the restoration of spontaneous cardiac activity. In the immediate postoperative period, the patient presented seizure activity, treated with TPS in continuous infusion (2 mg/kg/h) and DPH (250 mg/die). Anticonvulsant therapy didn't allow a correct neurologic evaluation of the patient; that was possible only when treatment was suspended (4 days after ICU admission). Neurophysiological investigations (EEG and Somato-Sensorial Evoked Potentials) were undertaken; particularly SSEPs recorded no pathologic alteration of the cortical response. At the discharge from ICU the patient was completely awake after coma, a residual paresis of the right lower limb was present. We suggest that in post-anoxic coma, when anticonvulsant therapy is required, neurophysiological investigations improve the accuracy of early outcome prediction.
我们报告一例长时间术中心脏骤停（15分钟）的病例，该病例发生在一名因右半胸枪伤导致失血性休克的患者身上；立即开始进行体外心脏按压并持续进行，直至恢复自主心脏活动。术后即刻，患者出现癫痫活动，采用持续输注硫喷妥钠（2mg/kg/h）和苯妥英钠（250mg/天）进行治疗。抗惊厥治疗妨碍了对患者进行正确的神经学评估；只有在停止治疗时（入住重症监护病房4天后）才有可能进行评估。进行了神经生理学检查（脑电图和体感诱发电位）；特别是体感诱发电位记录显示皮质反应无病理改变。从重症监护病房出院时，患者昏迷后完全清醒，右下肢存在残留麻痹。我们建议，在缺氧后昏迷需要抗惊厥治疗时，神经生理学检查可提高早期预后预测的准确性。
