Japanese
Title外傷性胸部大動脈損傷における麻酔管理についての検討
Subtitle原著
Authors舘田武志, 原康治, 坂本三樹, 杉原玄久, 木ノ内秀和, 宮里亨子, 青木正
Authors(kana)
Organization聖マリアンナ医科大学麻酔学教室
Journal循環制御
Volume19
Number2
Page230-236
Year/Month1998/
Article原著
Publisher日本循環制御医学会
Abstract「要旨」過去11年間における当院で施行された11例の外傷性胸部大動脈損傷の緊急手術における麻酔管理について生存群と死亡群に分け検討を加えた. 11例のうち2例は大量出血で術中に死亡し, 手術を施行した残り9例の内2例は術後多臓器不全および脳挫傷にて死亡した. 死亡群では生存群に比べ術前循環動態は不良であり, 術中出血量も大量であった, 麻酔管理は生存群ではフェンタニールを主体に行われ, 術中血管拡張薬と低用量カテコラミンが投与された. 一方死亡群では殆ど麻酔薬を使用出来なかった. 術中合併症は生存群では左心バイパス中の高血圧, 低酸素血症, 死亡群では大量出血による心停止であった. 胸部大動脈損傷の麻酔管理では大量出血への対処, 肺挫傷による低酸素血症の回避, 適切な循環動態の維持が重要であると考えられた.
Practice基礎医学・関連科学
KeywordsTraumatic thoracic aortic injury, Anesthetic management, Perioperative complication
English
TitleAnesthetic Management for Traumatic Thoracic Aortic Injuries
Subtitle
AuthorsTakeshi Tateda, Koji Hara, Miki Sakamoto, Haruhisa Sugihara, Hidekazu Kinouchi, Kyoko Miyazato, Tadashi Aoki
Authors(kana)
OrganizationDepartment of Anesthesiology, St. Marianna University School of Medicine
JournalCirculation Control
Volume19
Number2
Page230-236
Year/Month1998/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractWe analyzed the anesthetic management for 11 traumatic thoracic aortic, injuries received in traffic accident from 1986 to 1997. Two patients died of massive bleeding from injured thoracic aorta or liver laceration during operation. One patient died of being accompanied by brain contusion and one patient died of multiple organ failure after operation. These four patients were defined as non-survivor group. The remaining seven, who were defined as survivor group, underwent aortic repair under left heart bypass (graft : 5, direct suture : 2). Six patients of these discharged after surgical procedures, but one patient suffered from pulmonary edema and required respiratory therapy. In group non-survivor, preoperative hemodynamic states were unstable and large volume of blood were transfused because of massive bleeding during surgery. Although aggressive circulatory support was done in non-survivor group, three patients developed cardiac arrest during surgery and then two patients could not be resuscitated. In survivor group, combined fentanyl and volatile anesthetics or propofol were administered for anesthetic maintenance. Low dose catecholamine and vasodilators were also used for control of blood pressure during surgery in survivor group. Major intraoperative complications were hypertension during left heart bypass and hypoxemia in survivor group. We concluded that rapid blood transfusion for massive blood loss, prevention of hypoxemia with pulmonary contusion and maintenance of vital organ blood flow are essential for anesthetic management for traumatic aortic injury.
PracticeBasic medicine
KeywordsTraumatic thoracic aortic injury, Anesthetic management, Perioperative complication

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