| Japanese |
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| Title | 人工心肺離脱直後に原因不明の気道出血を来たした1症例 |
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| Subtitle | 症例 |
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| Authors | 本多泰子, 金澤雅, 笹野淳, 日野博文, 舘田武志 |
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| Organization | 聖マリアンナ医科大学麻酔学教室
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| Journal | 循環制御 |
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| Volume | 26 |
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| Number | 2 |
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| Page | 156-158 |
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| Year/Month | 2005/6 |
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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」人工心肺を使用する場合, 抗凝固薬としてヘパリンを用いることから, 思わぬ出血に遭遇することがある. 今回, 著者らは人工心肺離脱時に突然大量の気道出血を来たした症例を経験したので報告する. 症例77歳, 男性. 身長160cm, 体重53kg. 脳梗塞で他院内科通院中に心雑音を指摘され, 当院の心臓血管外科に紹介となった. 精査の結果, 大動脈弁狭窄症と診断され, 大動脈弁置換術が予定された. 既往歴に脳梗塞, 大腸癌(手術にて切除), 高血圧, 糖尿病が認められた. 脳梗塞の術前に残存する症状として右手に感覚障害があった. 術前内服薬はニフェジピン, カンデサルタンレキセチル, ニセルゴリン, シロスタゾールがあり, シロスタゾールは手術5日前に服用を中止とした. 術前胸部X線真や胸部CT検査では異常は認められなかった. 心臓超音波検査では, AVA=1.13cm2, PG=61.5mmHgと大動脈弁狭窄があり, 軽度の大動脈弁閉鎖不全も認めた. EFは95%, 左室壁運動に異常はなかった. 冠動脈造影検査では, #2：50% #6：50% #9：90% #15：75%と有意狭窄部位も認められたが, 狭心痛発作などの既往はこれまでにはなかった. 凝固機能検査はPT84%(INR1.11), aPTT27.7秒(対照値29.6秒)であり, 他には異常所見は認められなかった. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Endobronchial hemorrhage, cardiopulmonary bypass, aortic valve replacement |
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| English |
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| Title | Inadvertent bronchial hemorrhage after cardiopulmonary bypass in a patient who received aortic valve replacement |
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| Authors | Yasuko Honda, Masashi Kanazawa, Jun Sasano, Hirofumi Hino, Takeshi Tateda |
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| Organization | Department of Anesthesiology, St.Marianna University School of Medicine
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| Journal | Circulation Control |
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| Volume | 26 |
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| Number | 2 |
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| Page | 156-158 |
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| Year/Month | 2005/6 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 77-year-old man was scheduled for aortic valve replacement to treat his aortic stenosis. After induction of anesthesia with fentanyl and propofol, tracheal intubation was facilitated with vecuronium. A pulmonary artery catheter (PAC) was inserted via the right internal jugular vein without difficulty. The tip of the PAC was seen in the left pulmonary artery on a postoperative chest radiograph. The patient was separated from cardiopulmonary bypass (CPB). During protamine infusion, acute pulmonary hemorrhage occurred through the tracheal tube. Fiberoptic bronchoscopy revealed the right upper bronchus to be the source of bleeding. By this time, 500ml of blood had been lost through the endotrachel tube. The bleeding stopped within 30 minutes without any treatment. We administered aprotinin and antithrombin III to normalize blood clotting. No further bronchial bleeding occurred. We could not identify the cause of hemorrhage, although bronchiectasis, tracheal injury by tracheal intubation, PAC-related perforation of the pulmonary artery, perforation of pulmonary vein by ventricular vent catheter, or a metastatic pulmonary tumor from colon cancer were all considered. |
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| Practice | Basic medicine |
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| Keywords | Endobronchial hemorrhage, cardiopulmonary bypass, aortic valve replacement |
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