Okuyama K, Kashimoto S, Iwashita H, Kume M, Kumazawa T
Department of Anesthesiology, Yamanashi Medical University.
Masui. 1993 Sep;42(9):1363-6.
Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by asymmetric hypertrophy of the intraventricular septum, causing intermittent obstruction of the left ventricular outflow tract. General principles of management for HOCM include maintenance of adequate preload and afterload, and avoidance of tachycardia and increased myocardial contractility. A 57 year old male for subtotal gastrectomy and gastrojejunostomy received epidural anesthesia with epidural high dose fentanyl (0.5 mg) and 0.5% isoflurane with N2O and oxygen. Blood pressure and heart rate decreased mildly but were stable during the operation and during the recovery period from anesthesia without any complaints of pain. The results suggest that epidural high dose fentanyl anesthesia is a good method for patients with HOCM.
肥厚型梗阻性心肌病（HOCM）的特征是室间隔不对称肥厚，导致左心室流出道间歇性梗阻。HOCM的一般治疗原则包括维持足够的前负荷和后负荷，避免心动过速和心肌收缩力增加。一名57岁男性接受胃大部切除术和胃空肠吻合术，采用硬膜外麻醉，给予高剂量硬膜外芬太尼（0.5毫克）以及0.5%异氟烷与一氧化二氮和氧气混合使用。血压和心率轻度下降，但手术期间及麻醉恢复期均稳定，且无任何疼痛主诉。结果表明，硬膜外高剂量芬太尼麻醉对HOCM患者是一种良好的麻醉方法。
