| Japanese |
|---|
| Title | 拡張型心筋症を有した肝切除術の麻酔管理 |
|---|
| Subtitle | 症例 |
|---|
| Authors | 深田智子*, 小林なぎさ*, 立花千秋*, 佐藤啓子*, 古谷幸雄*, 大江容子* |
|---|
| Authors(kana) | |
|---|
| Organization | *東京女子医科大学附属第2病院麻酔科 |
|---|
| Journal | 循環制御 |
|---|
| Volume | 12 |
|---|
| Number | 4 |
|---|
| Page | 739-743 |
|---|
| Year/Month | 1991/ |
|---|
| Article | 報告 |
|---|
| Publisher | 日本循環制御医学会 |
|---|
| Abstract | 「要旨」拡張型心筋症(DCM)と診断された患者の肝切除術の麻酔を行い, 手術終了時に生じた頻脈発作に対しβ-遮断剤が有効であった症例を経験した. 症例は50才男性. 肺結核による胸郭形成術の既往があり, 肺機能障害がみられた. 心機能はNYHA分類I度であったが, 駆出率は40%であり, 左室の拡大と収縮力の低下が認められた. 麻酔はジアゼパム, フェンタニールで導入し, 笑気・酸素・イソフルレンで維持した. 術中, 安定した循環動態を得ていたが, 手術終了時に脈拍数が増加し, 血圧低下を生じた. 脈拍数減少の目的にてプロプラノロール2mgを緩徐に静注し, 脈拍数減少と血圧上昇がみられた. 本症例では頻脈発作に対し, DCMに比較的禁忌とされているβ-遮断剤の投与が有効であった. 「はじめに」拡張型心筋症(DCM)は心室の拡張と収縮不全を特徴とする疾患である. 今回, 胸郭形成術の既往があり, 術前検査にて本症と診断された患者の肝切除術の麻酔を経験したので報告する. 「症例」患者：50才男性. 現病歴：1990年4月に肝腫瘍精査のため当院外科を受診し, 9月14日に肝外側区域切除術が施行された. 既往歴：1967年に肺結核のため左胸郭形成術が行なわれた. |
|---|
| Practice | 基礎医学・関連科学 |
|---|
| Keywords | dilated cardiomyopathy (DCM), β-blocker, propranorol, tachycardia |
|---|
| English |
|---|
| Title | Intraoperative Management of Hepatic Lobectomy in Dilated Cardiomyopathy |
|---|
| Subtitle | |
|---|
| Authors | Tomoko Fukada, Nagisa Kobayashi, Chiaki Tachibana, Keiko Satoh, Yukio Furuya, Yoko Ohe |
|---|
| Authors(kana) | |
|---|
| Organization | Department of Anesthesiology Tokyo Women's Medical College daini hospital |
|---|
| Journal | Circulation Control |
|---|
| Volume | 12 |
|---|
| Number | 4 |
|---|
| Page | 739-743 |
|---|
| Year/Month | 1991/ |
|---|
| Article | Report |
|---|
| Publisher | Japan Society of Circulation Control |
|---|
| Abstract | β-blocker and Ca antagonist were relative contraindication to dilated cardiomyopathy (DCM). But we experienced that β-blocker, propranolol was effective for tachycardia in DCM. A 50-yr-old man, who was diagnosed DCM just before the hepatic lobectomy. The ejection fraction was 40% and dilated left ventircle and depression of LV contractility were shown in echocardiography and angiocardiography. In addition, he was obstructive and restrictive ventilatory impairment due to the left thoracoplasty. Anesthesia was induced with diazepam and fentanyl and maintained with fentanyl, isoflurane (below 1%), 60% N2O with O2. A pulmonary-artery catheter was inserted to monitor hemodynamics. During operation, hemodynamics was stable. But at the end of operation, heart rate was increased from 100 bpm to 150 bpm and systolic blood pressure was decreased from 150 mmHg to 90 mmHg. For the purpose of decreased heart rate, 2 mg propranorol was administrated. After propranorol was given, heart rate was decreased to 120 bpm and systolic blood pressure was increased to 110 mmHg. In this case, β-blocker was effective for tachycardia in DCM. |
|---|
| Practice | Basic medicine |
|---|
| Keywords | dilated cardiomyopathy (DCM), β-blocker, propranorol, tachycardia |
|---|