| Japanese |
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| Title | 精神分裂病患者に発症したA型解離性大動脈瘤における周術期管理の経験 |
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| Subtitle | 症例 |
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| Authors | 山本晋*, 笹栗志朗*, 山本平*, 福田智信*, 山崎元成*, 細田泰之*, 大沼徹** |
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| Authors(kana) | |
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| Organization | *順天堂大学医学部胸部外科, **順天堂大学医学部精神科 |
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| Journal | 循環制御 |
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| Volume | 18 |
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| Number | 1 |
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| Page | 88-92 |
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| Year/Month | 1997/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」精神分裂病患者に対する大動脈弓部置換術の周術期管理を経験した. 患者は43歳の男性であり, およそ20年間におよぶ向精神薬療法を施行されていた. 術前診断はA型解離性大動脈瘤であり, 診断確定後, 緊急手術となった. 手術は左anteroaxillary thoracotomyにて, 大動脈弓部に到達し, 超低体温循環停止, 逆行性脳灌流血により大動脈弓部置換を施行した. 術後12時間で覚醒し, 16時間後より体動を認めた. 術後第1病日より, 術前に投与されていた向精神薬を経管投与し, 第3病日から精神症状の予防を目的にハロペリドールの投与を開始した. 周術期を通して, 循環動態の悪化はなく, 大量の鎮静薬を必要とするような精神症状の悪化は認めなかった. 「はじめに」A型解離性大動脈瘤に対する大動脈弓部置換術は, 心臓血管手術の中でも手術侵襲が大きく, 周術期管理に難渋することがある. 今回は, 21歳時に精神分裂病を発症し, 精神科にて治療継続中にA型解離性大動脈瘤を発症した症例を経験した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Schizophrenia, Cardiac surgery, Dissecting aneurysm, Postoperative, Psychosis |
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| English |
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| Title | Perioperative Management of Dissecting Aneurysm for a Patient with Chronic Schizophrenia |
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| Subtitle | |
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| Authors | Shin Yamamoto*, Shiro Sasaguri*, Taira Yamamoto*, Tomonobu Fukoda*, Motonari Yamasaki*, Yasuyuki Hosoda*, Toru Onuma** |
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| Authors(kana) | |
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| Organization | *Departments of Cardiothoracic Surgery, Juntendo University, **Psychiatry, Juntendo University |
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| Journal | Circulation Control |
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| Volume | 18 |
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| Number | 1 |
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| Page | 88-92 |
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| Year/Month | 1997/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 43 year-old man with chronic schizophrenia underwent an total arch replacement for type A dissecting aneurysm. A diagnosis of schizophrenia was made at 21 years of age since then oral antipsychotic drugs had been given. The operation was made through the left antero-axillary thoracotomy, and the aortic arch was replaced using retrograde cerebral perfusion with deep hypothermic circulatory arrest. Twelve hours after surgery, the patient was awaked and struggled, then flunitrazepam was given intravenously. Oral antipsychotic drugs was started from the first postoperative day and haloperidol was infused intravenously at 1 mg/hr during midnight. He had been in stable psychiatric condition and his hemodynamics did not deteriorate after surgery. We believe that continuous infusion of haloperidol is effective to prevent deterioration of schizophrenia post operatively. (Circ Cont 18：88〜92, 1997) |
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| Practice | Basic medicine |
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| Keywords | Schizophrenia, Cardiac surgery, Dissecting aneurysm, Postoperative, Psychosis |
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