Anesthetic Management of Boerhaave's Syndrome

Boerhaave's Syndrome 麻醉處理之病例報告

朱希寧(Hsi-Ning Chu) ； 張嘉弘(Chia-Hung Chang) ； 許仲寬(Chung-Kun Hui) ； 許汝寧(Yu-Ling Hui)

《Acta Anaesthesiologica Taiwanica》 42卷2期 (2004/06) Pp. 103-106

摘要

Boerhaave's syndrome 是食道自然的破裂， 這是一種罕見的疾病， 如果沒有早期的診斷及有效的
治療， 它是會危及生命的。其發生的機轉可能是食道中食物殘留產生腐敗微生物， 胃液及消
化酵素等污染了縱膈腔， 發生縱膈炎及食道周圍壞死。如果能及早進行積極的外科清除治
療， 尚有一線生機， 否則最後只有死路一條。我們報告二個病例， 一個是早期外科清創治
療， 病人存活下來； 另一個是清創不夠， 發生縱膈腔炎， 後來不幸死亡。提醒同仁注意Boerhaave's
syndrome 是會致命的， 除了清創手術要做徹底， 手術過程中的麻醉處理也是相當重
要。由於病患通常會合併敗血症甚至休克， 麻醉誘導應使用適當的藥物， 麻醉中也必須注意
水分、電解質及酸鹼的平衡， 維持生命徵象， 才能保障病患的安全。

關鍵字

食道穿孔 ； 麻醉

並列摘要

Boerhaave's syndrome or spontaneous esophageal perforation is a life threatening condition which demands early
diagnosis and urgent management. Although very selective patients can be treated nonoperatively, in most patients,
better overall results can only be attained with early aggressive surgery. Clinical data and accounts of
anesthetic management of this condition scarely appear in medical literature. Managing these patients for surgery
is among the most challenging tasks facing the anesthesiologist because they may develop septic syndrome with
shock. A rapid-sequence induction is mandatory, and the procedures that may aggravate the injury to esophagus
should be avoided. Inotropic support and close attention to fluid balance may be required during operation. Because
Boerhaave's syndrome is rare, we report here two cases to illustrate possible anesthetic implications of this
disease. Both patients underwent thoracotomy to relieve empyema of mediastinumunder general anesthesia. The
first patient recovered completely after operation due to early diagnosis and treatment, but the second patient developed
multiple organ failure and died after operation due to delayed diagnosis of esophageal rupture and severe
sepsis. Because survival is directly related to the time to diagnosis and treatment, all clinicians need to be aware of
this lethal disease.

並列關鍵字

Esophageal perforation ； Anesthesia.