Tao A C, Chuah E C, Tung J C
Department of Anesthesiology, Tung's Hospital, Sha Lu, Taichung.
Acta Anaesthesiol Sin. 1994 Jun;32(2):133-6.
Intraoperative cyanosis is an utmost emergency for anesthesiologist. If the patient has adequate control ventilation, and normal cardiac pulmonary physiology, then methemoglobinemia must be considered. Reported here is a normal female with dark color lip on the second day after her second parturition and was undergoing tubal ligation. Twenty minutes after induction of general anesthesia and endotracheal intubation, dark blood at the incision site was noted by the operator. After emergent check up of the anesthesia machine, tubings, breathing sound and arterial blood gas, there was only one suspicion left. Methemoglobinemia was confirmed by the hematological examination. Methemoglobinemia is a product from the oxidation of the iron atom in the heme ring when oxygen dissociates from it. This process exists in nature, but can also be induced by nitrate or nitrite-containing drugs or foods or benzene-like organic compounds. Methemoglobinemia can be differentiated from normal hemoglobin by mass spectrometry. If acute illness develops, patients should be treated with methylene blue. Otherwise ascorbic acid will do. This case is reported to remind all anesthesia personnel about one of the rare but serious hemoglobinopathy.
术中发绀对麻醉医生来说是极其紧急的情况。如果患者通气控制良好，心肺生理功能正常，那么必须考虑高铁血红蛋白血症。本文报道了一位正常女性，在第二次分娩后第二天嘴唇颜色发深，正在接受输卵管结扎术。全身麻醉诱导和气管插管20分钟后，术者注意到切口处有深色血液。在对麻醉机、管道、呼吸音和动脉血气进行紧急检查后，只剩下一种怀疑。血液学检查证实为高铁血红蛋白血症。高铁血红蛋白血症是当氧从血红素环中解离时，血红素环中铁原子氧化的产物。这个过程在自然界中存在，但也可由含硝酸盐或亚硝酸盐的药物、食物或苯类有机化合物诱发。高铁血红蛋白血症可通过质谱法与正常血红蛋白区分开来。如果发生急性疾病，患者应使用亚甲蓝治疗。否则，维生素C也可以。报道此病例是为了提醒所有麻醉人员注意这种罕见但严重的血红蛋白病之一。
