Shiraishi M, Mizumura K, Hanzawa K, Wachi Y, Nitami K, Kamiyama Y
Department of Anesthesiology, Juntendo University Urayasu Hospital.
Masui. 1997 Jul;46(7):962-5.
An otherwise healthy 36-year-old housewife was diagnosed with advanced cancer of the stomach 5 months after her third parturition. Surgery was performed with the patient under total intravenous anesthesia combined with continuous epidural anesthesia. The course of anesthesia and the operative course were uneventful until the abdominal skin was sutured, when unexplained severe circulatory collapse developed. A widely dissociated PETCO2- PaCO2 suggested pulmonary embolism, and the findings of transesophageal echocardiography corroborated the diagnosis. Infusion of 480,000 units of urokinase in 30 minutes was immediately started via a Swan-Ganz catheter, and intravenous heparin 10,000 units in 24 hours, was administrated continuously. The pulmonary circulation was restored 30 minutes after the start of therapy, resulting in rapid recovery of the patient's systemic circulatory and acid-base status. The patient was safely extubated 19 hours postoperatively.
一位原本健康的36岁家庭主妇在第三次分娩5个月后被诊断出患有晚期胃癌。手术在患者全身静脉麻醉联合持续硬膜外麻醉下进行。麻醉过程和手术过程一直顺利，直到缝合腹部皮肤时，出现了原因不明的严重循环衰竭。PETCO2与PaCO2的显著分离提示肺栓塞，经食管超声心动图的检查结果证实了这一诊断。立即通过Swan-Ganz导管在30分钟内输注48万单位尿激酶，并持续静脉注射24小时10000单位肝素。治疗开始30分钟后肺循环恢复，患者的体循环和酸碱状态迅速恢复。患者术后19小时安全拔管。
