Sugita I, Uchida H, Koshizaki M, Saito Y, Kosaka Y, Yamamori Y
Department of Anesthesiology, Shimane Medical University, Izumo.
Masui. 1997 Jul;46(7):942-5.
We report a case of a postoperative brain infarction, in which an asymptomatic preoperative brain infarction was also revealed postoperatively. A 63-year-old man with bladder carcinoma was scheduled for the cystoplasty. The patient had no prominent preoperative abnormality. Anesthesia was maintained with isoflurane in N2O/oxygen combined with a spinal block and a continuous epidural block. Anesthesia lasted uneventfully for 16.5 hours. However, emergence from anesthesia was delayed. On the first postoperative day, motor aphasia and right hemiparalysis was confirmed. The computed tomography (CT) of the brain demonstrated a low density area in the frontoparietal region. The magnetic resonance imaging (MRI) indicated the corresponding lesion as the CT had demonstrated, and an old brain infarction in the parietal region. This meant that the patient had a history of asymptomatic brain infarction (ABI). Patients with ABI are considered to be a high-risk group for a brain infarction. It is important to evaluate the risk factors of brain infarction preoperatively and to minimize those risks during the operation. Maintenance of the cerebral perfusion pressure is imperative.
我们报告一例术后脑梗死病例，该病例术后还发现了术前无症状的脑梗死。一名63岁的膀胱癌男性患者计划接受膀胱成形术。患者术前无明显异常。采用异氟烷在笑气/氧气中维持麻醉，并联合蛛网膜下腔阻滞和持续硬膜外阻滞。麻醉顺利持续了16.5小时。然而，麻醉苏醒延迟。术后第一天，证实患者出现运动性失语和右侧偏瘫。脑部计算机断层扫描（CT）显示额顶叶区域有低密度区。磁共振成像（MRI）显示与CT所示相应的病变，以及顶叶区域的陈旧性脑梗死。这意味着患者有无症状脑梗死（ABI）病史。ABI患者被认为是脑梗死的高危人群。术前评估脑梗死的危险因素并在手术期间将这些风险降至最低非常重要。维持脑灌注压至关重要。
