Sunaguchi M, Imai H, Shigemi K, Imai R, Ozaki Y, Nakamura Y, Tanaka Y
Ootemae Hospital, Osaka.
Masui. 1998 Nov;47(11):1362-5.
We encountered a case of transient incomplete left bundle branch block (TILBBB) during standard mastectomy under general anesthesia. The patient was a 40 year-old female (70 kg, 164 cm) without any abnormalities on preanesthetic examinations except -61 degrees left axis deviation in exercise electrocardiogram. Adriamycin 20 mg was administered preoperatively. After the skin incision, heart rate increased from 104 min-1 to 130 min-1 and the cardiac axis gradually rotated leftward with increasing Q wave depth on leads I and aVL. We diagnosed this as blockade of the anterior branch in the left bundle branch. After the administration of fentanyl (0.2 mg) and sevoflurane (3%), the heart rate decreased to 105 min-1 and the electrocardiogram returned to the initial wave form. This anesthetic course indicated that adriamycin had slightly damaged the cardiac muscle and inadequate anesthesia had caused tachycardia and transient left bundle branch block. Left axis deviation on preoperative exercise electrocardiogram suggests that the left bundle branch can easily be blocked with an increasing heart rate. Adequate depth of anesthesia would have prevented the increase in heart rate and abnormality in the cardiac conduction process.
我们在全身麻醉下行标准乳房切除术时遇到了一例短暂性不完全性左束支传导阻滞（TILBBB）。患者为一名40岁女性（体重70kg，身高164cm），麻醉前检查除运动心电图显示电轴左偏61度外无任何异常。术前给予阿霉素20mg。皮肤切开后，心率从104次/分钟增至130次/分钟，心电轴逐渐向左旋转，I导联和aVL导联Q波深度增加。我们将此诊断为左束支前分支阻滞。给予芬太尼（0.2mg）和七氟醚（3%）后，心率降至105次/分钟，心电图恢复至初始波形。该麻醉过程表明阿霉素对心肌有轻微损害，麻醉不足导致心动过速和短暂性左束支传导阻滞。术前运动心电图电轴左偏提示左束支在心率增加时容易被阻滞。足够的麻醉深度可预防心率增加和心脏传导过程异常。
