| Japanese |
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| Title | CABG中のSWAN-GANZカテーテルの先進―心臓の前方への飜転との関係― |
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| Subtitle | 原著 |
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| Authors | 鈴木利保, 杵淵嘉夫, 竹山和秀, 滝口守, 山崎陽之介, 山本道雄 |
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| Organization | 東海大学医学部麻酔科学教室 |
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| Journal | 循環制御 |
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| Volume | 13 |
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| Number | 3 |
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| Page | 457-462 |
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| Year/Month | 1992/ |
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| Article | 原著 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」冠動脈バイパス(CABG)手術の中で, 心臓の後側に手術操作を加えるために, 心臓を飜転, 挙上する必要のある例では, その操作のために, Swan-Ganzカテーテル(以下PAC)の先端が先進しやすいと考えて, 過去32例のCABG例で, 非挙上例10例と飜転挙上例22例とPACの先進の程度を比較した. 飜転操作が必要なのは, 左回旋枝(鈍角枝, 後側壁枝), 右冠動脈(後下行枝)へのバイパスを行なう例で, 吻合のためと心拍を再開後止血を確認するために再度の飜転が必要である. 飜転の必要のない左前下行枝や対角枝へのバイパス例に比べ, 3cm以上の先進をしているものの頻度が高く68％で, そのうち41％がtrue wedge状態であった. 特に, cardioplegiaを解除後に頻回に飜転した4例は, 全例でtrue wedge状態であった. 人工心肺例でPACの先進が起こるのは虚脱によると考えられているが, 我々の結果から前方への飜転も大きな要因であると信ずる. この様な例では, 頻回のX線チェックが必要で, 先進が認められた時はPACを無菌的に出し入れできるスリーブの使用が望ましい. |
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| Practice | 基礎医学・関連科学 |
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| English |
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| Title | Swan-Ganz catheter migration during CABG surgery by anterior retraction of the heart |
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| Subtitle | |
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| Authors | Toshiyasu Suzuki, Yoshio Kinefuchi, Kazuhide Takeyama, Mamoru Takiguchi, Yonosuke Yamasaki, Michio Yamamoto |
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| Authors(kana) | |
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| Organization | Department of Anesthesiology,School of Medicine,TOKAI University |
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| Journal | Circulation Control |
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| Volume | 13 |
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| Number | 3 |
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| Page | 457-462 |
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| Year/Month | 1992/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We postulate that Swan-Ganz catheter would be nudged forward during surgical maneuver which involves anterior retraction of the heart to obtain a good surgical exposure of the posterior aspect. We studied the migration of catheter by post operative chest X-rays in 22 patients udergoing CABG surgery. Anterior retraction was necessary in those cases where left circumflex and right coronary arteries were involved (group 1) whereas the heart was left undisturbed in those cases where the whole surgical procedure could be carried out on the anterior aspect (left anterior descendibg and diagnonal arteries: group 2, 10 patients). In 68% of the cases in the first group the catheter was found to have advanced more than 3 cm further into the pulmonary artery and incidence of persistent wedging was 41%, while in the latter group the incidence were 20% and zero, respectively. In all the four patients in the first group who underwent repeated retractions to secure hemostasis on the posterior aspect of the heart, the catheter was wedged persistntly. Although the migration of the Swan-Ganz catheter in these cases has generally been attributed to collapse of the heart during CP bypass, vigorous manipulation of the heart with multiple anterior retractions may be just as commonly responsible. Repeated X-ray checks should facilitate an early diagnosis and prompt adjustment of the catheter positioning. |
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| Practice | Basic medicine |
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