Chen F C, Cherng C H, Hwang S J, Wong C S, Ho S T
Department of Anesthesiology, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1996 Dec;34(4):247-51.
Most of the lower limb surgeries are done under spinal anesthesia. This 21 year-old male had undergone open reduction with interlocking nail for his right femoral fracture and was scheduled for removal of interlocking nail. Spinal anesthesia was performed and a sensory block up to T8 level was achieved. During removing of the nail, the patient complained of chest pain, dyspnea and headache. Consequently, tachycardia and hypotension were observed. Then he coughed up pink frothy sputum. Ephedrine 5 mg was given to raise his blood pressure. About 3 min later, he recovered from the hypotension. Arterial blood gas analysis showed hypoxemia and hypercapnia. After endotracheal intubation, he was sent to surgical intensive care unit. In surgical intensive care unit, fat globules in urine, anemia and thrombocytopenia were noted. Chest roentgenogram showed patchy pulmonary infiltrates in the left lower lobe. A pulmonary artery catheter was inserted for pulmonary measurement, which read pulmonary artery pressure 45/28 mmHg, wedge pressure 14 mmHg, and cardiac output was 5-34 L/min. Supportive treatment which included steroid therapy, and O2 therapy with positive end-expiratory pressure was initiated under the impression of pulmonary embolism. The course in surgical ICU was uneventful and he left there three days later and was discharged on the fifth hospitalization day.
大多数下肢手术是在脊髓麻醉下进行的。这位21岁男性因右股骨骨折接受了切开复位交锁髓内钉固定术，现计划取出交锁髓内钉。实施了脊髓麻醉，感觉阻滞平面达到T8水平。在取出髓内钉过程中，患者主诉胸痛、呼吸困难和头痛。随后观察到心动过速和低血压。接着他咳出粉红色泡沫痰。给予5毫克麻黄碱以升高血压。约3分钟后，他从低血压状态恢复。动脉血气分析显示低氧血症和高碳酸血症。气管插管后，他被送往外科重症监护病房。在外科重症监护病房，发现尿中存在脂肪球、贫血和血小板减少。胸部X线片显示左肺下叶有斑片状肺浸润。插入肺动脉导管进行肺功能测量，结果显示肺动脉压为45/28 mmHg，楔压为14 mmHg，心输出量为5 - 34 L/分钟。在考虑肺栓塞的情况下，开始了包括类固醇治疗和呼气末正压给氧在内的支持治疗。在外科重症监护病房的病程平稳，三天后他离开该病房，并于住院第五天出院。
