- 期刊
Complete Heart Block after Epidural Analgesia in a Thymectomy Patient
胸腺瘤切除後接受脊髓硬膜上止病術產生之完全性房室阻斷：病例報告
摘要
胸腺瘤是成人前縱膈空常見之腫瘤，手術是最好之治療方式。目前標準開胸術可能會影響臟傳導系統。而在脊髓硬膜止痛術或脊髓麻醉中之bupivacaine藥物如果注射至血中會造成房室傳道阻斷。而在脊髓硬膜止痛術中若作用在脊髓的高度太高(胸椎神經1-4)。就可能阻斷心臟之交感神經作用而增加副交感神經作用，進而產生心律不整(心博過慢，甚至房室傳導阻斷)。我們報告此個案為一有巨大之胸腺瘤，接受胸腺切除術並接受脊髓硬膜止痛術後，產生完全房室傳導阻斷之現象。
並列摘要
Thymomas are common anterior medastinal tumors in adults, for which surgery is the best treatment. The method of approach (sternotomy) may affect the cardiac coduction system. Atrioventriculor block (A-V block) of the heart is also a side effect of bupivacaine with epidural or spinal anesthesia, if the concen-tration of bupivacaine is high and it is injected in the plasma. If the level of epidural analgesia is too high (T1-T4), the sympathetic tone of the heart may be blocked and exaggerated its parasympathetic tone. Arrythmia (bradycardia with A-V block) may be induced. We present a female patient with a huge thymoma who received a thymectomy and who developed serial complete A-V block following postoperative epidural analgesia in the surgical intensive care unit.
延伸閱讀
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