Japanese
Title腹部大動脈瘤と冠動脈狭窄に対する同時手術の麻酔経験
Subtitle症例
Authors美馬裕之, 石田裕之, 久野太三, 辻本三郎, 加藤浩子
Authors(kana)
Organization神戸市立中央市民病院麻酔科
Journal循環制御
Volume17
Number1
Page94-98
Year/Month1996/
Article報告
Publisher日本循環制御医学会
Abstract「要旨」腹部大動脈瘤(AAA)に虚血性心疾患(CAD)が合併した場合, 先に冠動脈バイパス手術を行い, その後AAA手術をする2期的手術が一般的であり, 同時手術の報告は少ない. 我々は過去2年間に5例の同時手術を経験した. 5例全例が生存し, うち3例は合併症もなく早期に退院できた. 術前の心機能が比較的良好で合併症もなかったこと, 体外循環下に腹部大動脈を遮断することにより遮断によるストレスから心臓を保護したことなどが成功の要因と考えられた. CADを合併したAAAに対する手術法の選択は, 同時手術も含めて検討してよいと考えられる. 「緒言」腹部大動脈瘤(以下AAA)には虚血性心疾患(以下CAD)が高率に合併する. AAA手術では, 出血による循環血液量の急激な変化や腹部大動脈の遮断, 遮断解除に伴う左室壁ストレスの増大や冠灌流圧の減少により心筋虚血が増悪する可能性があり, 心筋虚血はAAA手術の周術期合併症の最大の問題となっている1).
Practice基礎医学・関連科学
KeywordsCoronary artery disease, Abdominal aortic aneurysm, CABG, Combined procedure
English
TitleAnesthetic Management of Patients Undergoing Abdominal Aortie Aneurysm Resection Combined with Coronary Artery Bypass Grafting
Subtitle
AuthorsHiroyuki Mima, Hiroyuki Ishida, Taizo Hisano, Saburo Tsujimoto, Hiroko Kato
Authors(kana)
OrganizationDepartment of Anesthesia, Kobe City General Hospital
JournalCirculation Control
Volume17
Number1
Page94-98
Year/Month1996/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractPatients with abdominal aortic aneurysm (AAA) frequently have coexistent coronary artery disease (CAD). In this setting, a staged procedure of coronary artery bypass grafting (CABG) followed by AAA surgery is common, but a combined procedure may be alternative. We experienced the anesthetic and postoperative management of 5 patients undergoing combined CABG and AAA surgery from 1992 to 1994. Anesthesia was induced and maintained with midazolam and fentanyl. In all patients CABG was done first, and AAA recection was performed without CPB in 2 patients and on normothermic CPB in the remaining 3. In the former patients, anesthesia was supplemented with isoflurane during AAA repair. Three patients were discharged from the intensive care unit on the 3rd postoperative day without any complications. In the remaining 2 patients, the hospital stay was prolonged because of postoperative complications. All patients survived eventually without cardiac complications. It is suggested that AAA surgery on CPB has advantage of avoiding an undue stress on the myocardium, especially at the time of aortic clamping and declamping. (Circ Cont 17：94〜98, 1996)
PracticeBasic medicine
KeywordsCoronary artery disease, Abdominal aortic aneurysm, CABG, Combined procedure

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