Anesthesia for Patients with Aortic Aneurysm for Non-Aneurysmal Surgery-A Retrospective Study

主動脈廇病患接受非動脈廇手術之麻醉處置－追溯研究

王致嫻(Chih-Hsien Wang) ； 鄭國偉(Kwok-Wai Cheng) ； 姚文聲(Bruno Jawan) ； 李汝浩(Ju-Hao Lee)

《Acta Anaesthesiologica Sinica》 38卷1期 (2000/03) Pp. 3-7

https://doi.org/10.6955/AAS.200003.0003

摘要

背景：主動脈廇是高危險性疾病，它的破裂與否及是否需要開刀治療通常是決定在主動脈瘤的大小　、種類和症狀。而手術及麻醉時引起的血壓波動，可能會造成動脈瘤的破裂進而致命，因此此種手術的麻醉是相當具有挑戰性，尤其此病患要接受非動脈廇手術進，更是讓麻醉科醫師戰戰兢兢。過去有關此種病人麻醉方面的文獻報告甚少，本篇收集了自1992-1998年共十一位此類病患的相關資料予以研究討論。
方法：八位是胸腔主動脈瘤剝離者，三位是腹腔主動脈廇病患。由於他們都未達到外科治療的絕對性適應症，因此僅接受因其他疾病引起的非動脈瘤矯正的腹腔手術。我們回顧病患的基本資料、手術種類、麻醉方法，及麻醉中血壓變化、藥物給予、監視器的使用及目前存活率。
結果：十一位病患皆未因麻醉或開刀而造成動脈廇破裂。其中七位目前仍存活中。
結論：對於患有主動脈廇但沒有外科切除的絕對性適應症的病患，卻因其他疾病必須接受腹腔手術時，若能在精密儀器監控下早期且快速處置血液動力學的改變，則可使血壓波動速度減慢，並降低動脈廇在麻醉或開刀中破裂的機會。

關鍵字

胸部及腹部主動脈瘤 ； 腹部探測術 ； 主動脈破裂 ； 全身麻醉

並列摘要

Background: Most anesthesiologists at one time or other saw the anesthetic management of patients with aortic aneurysm who underwent surgical procedures other than correction of aneurysm with or without prior knowledge of the existence of the aneurysm. The risk of intraoperate rupture of aneurysm depends on its size, type, severity, and presentation of symptoms; stress and unstable hemodynamics have been usually held responsible for the aggravation and even rupture of aneurysm. There are numerous other factors that affect the hemodynamic force during anesthesia and surgery, the inercase of which would be very dangerous to the surgical patients with aortic aneurysm whether they receive anesthesia for a radical correction of the disease per se or for a surgical procedure unrelated to its correction. Therefore the anesthetic management of a patient with aortic aneurysm is a great challenge which the anesthesiologist must accept. Here, we present eleven cases of aortic aneurysm, who underwent non-corrective surgery during 1992-1998.
Methods: There were eight cases of thoracoaortic dissecting aneurysm and three cases of abdominoaortic aneurysm. All underwent laparotomy under general anesthesia without the aneurysm being corrected. We reviewed the anesthetic management of these patients retrospectively.
Results: Our review showed that no aneurysm rupture was noted in these eleven cases. Seven of the eleven patients are still alive at the lime of this report.
Conclusions: We are of the opinion that under close monitoring and with prompt treatment, the allowance of a slow climb of arterial pulse pressure is acceptable and would not increase the risk of aneurysm rupture.

並列關鍵字

Aortic aneurysm, thoracic and abdominal ； Laparotomy ； Aortic rupture ； Anesthesia, general