| Japanese |
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| Title | 脊硬麻で管理した拡張型心筋症合併の帝王切開手術 |
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| Subtitle | 症例 |
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| Authors | 久野健二郎, 青木剛太, 玉花, 森本裕二, 劔物修 |
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| Organization | 北海道大学大学院医学研究科侵襲制御医学講座侵襲制御医学分野 |
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| Journal | 循環制御 |
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| Volume | 23 |
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| Number | 4 |
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| Page | 441-444 |
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| Year/Month | 2002/ |
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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 | はじめに 拡張型心筋症（DCM）は心室の拡大と収縮能の著明な低下を特徴とする疾患である. 帝王切開に合併した場合, 母児共に危険性に曝されることが予想されるが, 麻酔管理についての文献報告は少ない. 今回妊娠時に発見された拡張型心筋症に対し, 脊髄くも膜下硬膜外併用麻酔（脊硬麻）で管理できた症例を経験したので報告する. 症例 患者は24才の女性で, 身長148cm, 体重50.9kg（非妊娠時43kg）, 推定体表面積1.43m2であった. 既往歴：幼少児の検診で指摘された心室中隔欠損（VSD）があった. 高校在学時まで経過観察されていたが臨床症状がないため, 受診を自己中断していた. 現病歴：妊娠後在胎24週（胎児推定1121g）時に悪阻と共に動悸を自覚したため, 心エコー検査が施行され, DCMとVSD残存が疑われ当院産婦人科に入院となった. 入院時の検査で心室上部のVSD左右シャント（Qp/Qs1.2）, 左室駆出率（LVEF）0.34, 短縮率（％FS）0.18, 左室拡張期径（LVIDd）57mm=40mm/m2, 心室中隔壁厚（IVST）8mm, 左室後壁厚（LVPWT）7mm, 心胸郭比（CTR）55％と心室壁の菲薄化を伴う心拡大, 収縮の低下が見られ, 心電図上多形性PVCが散発していた. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Dilated cardiomyopathy, Cesarean section, Combined spinal-epidural anesthesia |
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| English |
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| Title | Combined Spinal-Epidural Anesthesia for Cesarean Section in a Patient with Dilated Cardiomyopathy. |
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| Authors | Kenjiro Hisano, Gota Aoki, Yu Hua, Yuji Morimoto, Osamu Kemmotsu |
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| Authors(kana) | |
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| Organization | Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine |
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| Journal | Circulation Control |
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| Volume | 23 |
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| Number | 4 |
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| Page | 441-444 |
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| Year/Month | 2002/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 24-year-old patient with dilated cardiomyopathy （DCM） underwent an elective Cesarean section. Anesthesia was induced by combined spinal-epidural anesthesia after inserting catheters into the radial artery for direct blood pressure monitoring and internal jugular vein with continuous infusion of dopamine 3μg/kg/min. First, isobaric bupivacaine 5mg and fentanyl 10μg were administered into the subarachnoidal space through the L4/5 interspace. Bupivacaine 49mg and fentanyl 50μg were supplemented for epidural anesthesia through an epidural catheter at the L2/3 interspace after confirming spinal analgesic level. Analgesic level was sufficient （T4-S） and hemodynamics including blood pressure and heart rate were stable during surgery. Central venous pressure（CVP）monitoring was useful for preventing supine hypotensive syndrome and elevation of CVP observed after expulsion. A baby （2750g） was delivered uneventfully with good Apgar score （8 for 1 min, 9 for 5 min） The stable hemodynamic state and effective analgesia were successively obtained postoperatively by continuous epidural administration of bupivacaine and fentanyl. |
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| Practice | Basic medicine |
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| Keywords | Dilated cardiomyopathy, Cesarean section, Combined spinal-epidural anesthesia |
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