Acute Fatal Vasoplegia and Asystole Induced by Intravenous Amiodarone after Cardiopulmonary Bypass in a Patient with Preoperative Cardiogenic Shock

單次靜注Amiodarone已被廣爲使用，且在心臓手術中被證實對心室上性和心室性不整脈有效。我們在此報告一位六十歲婦女，她發生不穩定性心絞痛，無法因使用硝化甘油而消除症狀，又因於心導管室施行經皮入腔冠狀血管整形術時，發生心因性休克，而被送入手術室施行緊急冠狀動脈繞道術。經過兩小時，完成三條血管植入，並在強劑和主動脈內氣球幫浦的支撐下，成功脫離外循環。但卻在魚精蛋白輸注後，發生心室性不整脈，而且無法由利多卡因注射而平息。因此給予緩慢單劑量Amiodarone(3μg/kg)，而有改善。不幸十分鍾後發生了急性血管失能（麻痺）和無心跳情況，即使全力急救，病患仍然死亡。我們在此文中對於造成此等Amiodarone之並發症的機轉，可能的危險因素和處置，做些回顧和討論。

關鍵字

Amiodarone ；心因性休克；術中併發症：無心跳

並列摘要

Single dose intravenous amiodarone has been widely used and shown to be effective to treat supraventricular and ventricular arrhythemias in cardiac surgery. We, herein, report a 60-year-old female patient, sustaining cardiogenic shock in the course of percutaneous transluminal coronary angioplasty (PTCA) for unstable angina unrelieved by medication including nitroglycerin, succumbed to a life-saving emergent coronary artery bypass grafting (CABG) operation at the end of cardiopulmary bypass (CPB) following a 180 mg bolus dose of amiodarone (3 mg/kg) directed at the ventricular arrhythmias, triggered by protamine and unresponsive to lidocaine treatment. Amiodaroneinduced asystole and vasoplegia were thought to be the causation of the failure of resuscitation. The causes of the development of these complications, the potential hazards of its use and the management relative to the consequential complications are reviewed and discussed.

並列關鍵字

Amiodarone ； Shock: cardiogenic ； Intraoperative complication: asystole

國際替代計量

Acute Fatal Vasoplegia and Asystole Induced by Intravenous Amiodarone after Cardiopulmonary Bypass in a Patient with Preoperative Cardiogenic Shock

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