Intraoperative Stroke Under Epidural Anesthesia for Bipolar Hemiarthroplasty in a Patient with Multiple Myeloma: a Case Report

多發性骨髓瘤病患於硬脊膜外麻醉下接受雙極式人工髖關節置換術時發生術中腦部中風－病例報告

王建仁(Chien-Jen Wang) ； 程廣義(Kuang-I Cheng) ； 蘇理盈(Lee-Ying Soo) ； 湯兆舜(Chao-Shun Tang)

《The Kaohsiung Journal of Medical Sciences》 17卷1期 (2001/01) Pp. 55-59

https://doi.org/10.6452/KJMS.200101.0055

摘要

一位58歲、56公斤，罹患右股骨頸骨折的女性病人準備接受雙極式人工髖關節置換手術（bipolar hemiarthroplasty）。她的過去病史包括糖尿病和多發性骨髓瘤（multiple myeloma）。硬脊膜外麻醉（epidural anesthesia）執行的過程相當順利；除了局部麻醉劑（2％lidocaine）以外，並沒有加入其他任何麻醉鎮靜劑。但是很不幸地，在這位病人身上，我們親眼目睹了因為腦部中風所引起的由低到高的戲劇性的血壓變化。這次中風事件病人先以意識清醒度下降來表現，並且經由四天後的腦部電腦斷層來加以證實。許多因素，諸如術中的低血壓以及病人因為長期罹患糖尿病所導致的週邊血管硬化，可能跟此次術中腦部中風有關。另外，在以往有關中風文獻上甚少被提及的多發性骨髓瘤，亦是導致此次術中腦部中風的一個極重要的危險因子。在本文中，我們將有詳盡的討論。

並列摘要

A 56-yr-old, 58-kg woman with right femoral neck fracture underwent right bipolar hemiarthroplasty. Her medical problems included diabetes mellitus and multiple myeloma. Epidural anesthesia was performed uneventfully. No other drug except for local anesthetic (2% lidocaine) was administered during the procedure. Unfortunately, we “witnessed” the dramatically hemodynamic change of an intraoperative stroke, which was preceded by a hypotensive episode and followed by sustained hypertension. The stroke was presented with decreased level of consciousness initially and confirmed by the brain CT, which revealed acute infarction at the right middle cerebral artery territory, four days after the procedure. Multiple mechanisms such as intraoperative hypotensive episode and vascular atherosclerotic change due to poor controlled diabetes mellitus might. Be involved in the event. In the meanwhile, hyperviscosity ( 3.7 centipoise units of the patient v.s. 1.4-1.8 centipoise units of normal range) caused by multiple myeloma might also have contributed to the intraoperative stroke. Clinical presentation of this case will be discussed.

並列關鍵字

intraoperative stroke ； epidural anesthesia ； multiple myeloma ； bipolar hemiarthroplasty