| Japanese |
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| Title | 純型肺動脈閉鎖症に対する肺動脈弁切開術(Brock手術)の周術期管理 |
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| Subtitle | 原著 |
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| Authors | 堀之口典子, 畔政和 |
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| Authors(kana) | |
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| Organization | 国立循環器病センター麻酔科 |
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| Journal | 循環制御 |
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| Volume | 18 |
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| Number | 3 |
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| Page | 376-382 |
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| Year/Month | 1997/ |
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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」Brock手術を行った32例について術前・術中・術後の管理についてretrospectiveに調査・検討した. 術前肺血流を動脈管(PDA)に期待できない症例が6例あり, プロスタグランジンは28例に投与されていた. 7例が心不全に対してカテコラミンを必要としていた. 術中はvalvotomy前後で急激に血行動態が変化し, 半数の症例がカテコラミンを必要とした. 術前重症の心不全を呈していた2例は術中死した. Valvotomy後全例プロスタグランジンの投与は中止した. 術後は心不全が進行しカテコラミンを必要とした症例は25例に増加し, 3剤以上の投与を必要とした症例が6例あった. 多剤を必要とした症例は体-肺動脈短絡術(shunt術)を同時に行ったり, 術後PDA血流量が増加した症例で, shuntの切断やPDA banding, 解熱鎮痛剤の投与を行った. 術後1週間以内死亡例の83%の死因が心不全であった. 術後低酸素血症が進行し20例にプロスタグランジンを再投与し, 6例が初回手術後1ヶ月以内にshunt術を行った. 早期死亡率は43.3%で従来報告されているように予後不良であった. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Pulmonary valvotomy, Pulmonary atresia, Perioperative management |
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| English |
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| Title | Perioperative Management of Patients undergoing Pulmonary Valvotomy for Pulmonary Atresia or Critical Pulmonary Stenosis and Intact Ventricular Septum |
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| Subtitle | |
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| Authors | Noriko Horinokuchi, Masakazu Kuro |
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| Authors(kana) | |
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| Organization | Departrment of Anesthesiology, National Cardiovascular Center |
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| Journal | Circulation Control |
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| Volume | 18 |
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| Number | 3 |
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| Page | 376-382 |
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| Year/Month | 1997/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We reviewed the management of 32 patients undergoing pulmonary valvotomy (Brock procedure) as an initial surgery for pulmonary atresia or critical pulmonary stenosis and intact ventricular septum. While pulmonary blood flow did not depend on the patent ductus arteriosus (PDA) in six patients, prostaglandin was administered in 28 patients and seven patients recieved preoperative catecholamine treatment. Hemodynamic changes were so dramatic following pulmonary valvotomy that half of patients required infusion of catecholamine and two patients with severe preoperative heart failure died on the operating table. No patients needed prostaglandin infusion after valvotomy. Twenty five patients were managed with postoperative catecholamines for heart failure and six of them needed three or more kinds of catecholamines. Patients requiring two or more catecholamines suffered from excessive increasing of pulmonary blood flow through surgical systemic-pulmonary shunt or PDA. Thus, they underwent division of the shunt, banding of the PDA, or antipyretics treatment. Eighty three percent of cause of death within one week was heart failure. Prostaglandin was infused again in 20 patients because of persistent hypoxemia and an additional systemic-pulmonary shunt was placed in six patients within one month after the valvotomy. Early motality was 34.3%, which was similar to those reported previously. |
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| Practice | Basic medicine |
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| Keywords | Pulmonary valvotomy, Pulmonary atresia, Perioperative management |
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