Cardiogenic Shock Following Functional Endoscopic Sinus Surgery-A Case Report and Review of the Literature

功能性鼻竇內視鏡手術術後之心因性休克－個案報告及文獻回顧

吳伯軒(Po-Hsuan Wu) ； 鄭博文(Po-Wen Cheng)

《台灣耳鼻喉頭頸外科雜誌》 52卷3期 (2017/09) Pp. 105-108

https://doi.org/10.6286/2017.52.3.105

摘要

Post-operative coronary artery spasm, a rare condition in otolaryngological surgery, is shown to play an important role in the pathogenesis of myocardial infarction, which may subsequently induce cardiogenic shock. Oriental elderly male patients with coronary risk factor are shown to be more susceptible in this condition; however, the incidence is less than 0.05% in non-cardiac surgery according to the reported literature. In this report, we presented a 47-year-old male heavy smoker, who underwent functional endoscopic sinus surgery, and suffered from two episodes of myoclonus, chest tightness and hypotension during the postoperative period. Electrocardiography revealed mild ST elevation over Lead II, III and aVF; however, laboratory study showed no cardiac enzyme abnormality. Consciousness change and cardiac arrest with ventricular fibrillation were noted subsequently. Cardio-pulmonary-cerebral resuscitation was performed and the patient was sent for percutaneous coronary intervention (PCI) after return of spontaneous circulation. The PCI showed proximal right coronary artery spasm with distal thrombus formation. The patient recovered after the procedure and echocardiography later reported good left ventricle contractility (LVEF: 69%) with very mild left ventricle regional wall motion abnormality over right coronary artery territory. He was then discharged from our hospital under fair condition. Although the incidence of post-operative coronary artery spasm complicated with cardiogenic shock was quite low, this could be a lethal situation without early detection and appropriate management.

關鍵字

Coronary artery spasm ； functional endoscopic sinus surgery ； myocardial infarction

並列摘要

術後發生的冠狀動脈痙攣在耳鼻喉科手術中相當少見，它在心肌梗塞的形成中佔有重要的角色，並可能導致心因性休克。此疾病較多發生於有冠狀動脈危險因子的東方年長男性病人；然而根據文獻上報告，冠狀動脈痙攣在非心臟手術的發生率小於萬分之五。本篇案例報告中提及1名47歲重度吸煙男性，他在功能性鼻竇內視鏡手術後經歷了兩次全身性肌肉陣攣、胸悶及低血壓的情況。術後心電圖可看出在導極II, III及aVF有ST波上升的情況；抽血檢查心臟酵素無異常。之後發生心跳停止合併心室顫動及意識狀態改變。心肺腦復甦術隨即執行，並且在病人成功恢復自發性循環後安排冠心病介入性治療，發現右冠狀動脈血管痙攣及遠端血栓形成。病人在藥物治療後病情迅速恢復出院，心臟超音波檢查報告左心室收縮力良好(LVEF: 69%)及極度輕微左心室壁之右冠狀動脈供應區域運動異常。病人於是在恢復良好的狀態下出院。雖然術後發生的冠狀動脈痙攣合併心因性休克發生率極低，若無法及時偵測並妥善處理，臨床上仍可能會發生致命的情況。

並列關鍵字

Coronary artery spasm ； functional endoscopic sinus surgery ； myocardial infarction（冠狀動脈痙攣 ； 功能性鼻竇內視鏡手術 ； 心肌梗塞）