| Japanese |
|---|
| Title | 麻酔導入時の経食道心エコーによって術式が変更された外傷性大動脈損傷の1症例 |
|---|
| Subtitle | 症例 |
|---|
| Authors | 吉田結富子, 寺嶋克幸, 伊藤公亮, 山梨義高, 横塚基, 竹森健, 三井誠司, 佐藤千代, 中西一浩, 坂本篤裕 |
|---|
| Authors(kana) | |
|---|
| Organization | 日本医科大学麻酔科学教室
|
|---|
| Journal | 循環制御 |
|---|
| Volume | 27 |
|---|
| Number | 4 |
|---|
| Page | 362-365 |
|---|
| Year/Month | 2006/12 |
|---|
| Article | 報告 |
|---|
| Publisher | 日本循環制御医学会 |
|---|
| Abstract | 「はじめに」麻酔導入時の経食道心エコーによって術式が変更された外傷性大動脈損傷の1症例を経験したので報告する. [症例]症例は51歳男性, 身長175cm, 体重75kg. 踏切近傍で電車と接触して受傷した. 既往歴はない, 入院時現症は, 血圧78/測定不可, 心拍83, 呼吸数28, 体温35.8, 意識レベルGCS11(E3V3M5)であった. 検査所見：動脈血;pH7. 305, pO2 89.6mmHg, pCO2 30.4mmHgであった. 胸部CT所見(造影図1, 2);左鎖骨下動脈基部の拡張, 左鎖骨下動脈分岐部より下0.5cmから5cmにわたる外傷性大動脈解離, 左多発肋骨骨折, 血気胸, 脾損傷, 左腎損傷, 左第5番MP関節骨折を認めた. 前医にて左血気胸に対し胸腔ドレナージチューブを挿入, フレイルチェストに対し気管内挿管および人工呼吸を施行された. 処置後の胸部レントゲン写真にて, 上縦隔の拡大, 気管の右方偏移を認めた(図3), 受傷1日後, 手術目的にて当院に搬送された. 手術室入室時BP135/60mmHg, HR100回/分. 人工呼吸下にプロポフォール200mg/h, フェンタニル80μg/h, ベクロニウム5mg/h, プロプラノロール80μg/hを持続投与されていた. |
|---|
| Practice | 基礎医学・関連科学 |
|---|
| Keywords | |
|---|
| English |
|---|
| Title | Diagnosis of the Region of Traumatic Aortic Injury by Transesophageal Echocardiography prior to Surgery changed the Operative Procedure |
|---|
| Subtitle | |
|---|
| Authors | Yuko Yoshida, Katsuyuki Terajima, Kimiyasu Itou, Yoshitaka Yamanashi, Motoi Yokoduka, Ken Takemori, Seiji Mii, Chiyo Sato, Kazuhiro Nakanishi, Atsuhiro Sakamoto |
|---|
| Authors(kana) | |
|---|
| Organization | Department of Anesthesiology Nippon Medical School
|
|---|
| Journal | Circulation Control |
|---|
| Volume | 27 |
|---|
| Number | 4 |
|---|
| Page | 362-365 |
|---|
| Year/Month | 2006/12 |
|---|
| Article | Report |
|---|
| Publisher | Japan Society of Circulation Control |
|---|
| Abstract | A 51 year-old man was admitted for displacement of the discending aorta for traumatic aortic injury. After induction of anesthesia, we inserted a transesophageal echocardiography probe and found dissection of the discending aorta, dilatation of the proximal part of the left subclavian artery and exfoliation of inner and mediam membrane of the left subclavian artery. The scheduled operation was displacement of discending aorta (simply clamp and direct reconstruction using percutanous cardiopulmonary support). We thought this operation procedure might cause rupture of the left subclavian artery, therefore the operation was postponed, and catheter arteriography was performed. The arteriography only showed dilatation of the left subclavian artery and dissection of the discending aorta and the left subclavian artery was unclear. Although sensitivity and specificities of transesophageal echocardiography for diagnosis of traumatic aortic injury are not higher than that of computed tomography and catheter arteriography, transesophageal echocardiography was very useful for diagnosis of traumatic aortic injury, and should be performed prior to surgery if possible. |
|---|
| Practice | Basic medicine |
|---|
| Keywords | traumatic aortic injury, transesophageal echocardiography |
|---|