颈椎融合术后急性心肌梗死老年患者限期颈椎翻修术的麻醉与围术期管理  

Anesthesia and perioperative management of an elderly patient with acute myocardial infarction undergoing semi-elective cervical revision surgery after cervical fusion

作　　者：田甜 肖玮[1] 王强 申乐[3] 侯志勇[4] 马利杰[4] 王治乾[5] 王宁[6] 尹春琳[7] 王秀丽[8] 薛张纲 王天龙[1] 黄宇光[3] Tian Tian;Xiao Wei;Wang Qiang;Shen Le;Hou Zhiyong;Ma Lijie;Wang Zhiqian;Wang Ning;Yin Chunlin;Wang Xiuli;Xue Zhanggang;Wang Tianlong;Huang Yuguang(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Anesthesiology,Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Anesthesiology,Peking Union Medical College Hospital Chinese Academy of Medical Science&Peking Union Medical College,Beijing 100730,China;Department of Orthopedics,The Third Hospital of Hebei Medical University,Shijiazhuang 050017,China;Department of Cardiology,The Third Hospital of Hebei Medical University,Shijiazhuang 050017,China;Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Cardiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Anesthesiology,The Third Hospital of Hebei Medical University,Shijiazhuang 050017,China;Department of Anesthesiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科,北京100053 [2]西安交通大学附属医院麻醉科,710061 [3]中国医学科学院北京协和医学院北京协和医院麻醉科,100730 [4]河北医科大学第三医院骨科,石家庄050017 [5]河北医科大学第三医院心脏内科,石家庄050017 [6]首都医科大学宣武医院神经外科,北京100053 [7]首都医科大学宣武医院心脏内科 [8]河北医科大学第三医院麻醉科,石家庄050017 [9]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中华麻醉学杂志》2021年第10期1177-1179,共3页Chinese Journal of Anesthesiology

摘　　要：一、病例介绍1.病史摘要(1)一般情况:患者男性,年龄63岁,因行走不稳伴脚底麻木1年,双下肢踩棉花感1个月入院。患者于26 d前行颈椎前路手术,术后左肩肘部活动受限,CT示椎体及固定系统移位。22 d前拟行颈椎翻修术,患者入室时诉胸闷胸疼,心电图示:Ⅲ导联Q波形成,ST段抬高,T波倒置,TnI 4.3 ng/ml,CK-MB 149 ng/ml,Myo 302 ng/ml,BNP 1780 ng/L,考虑"急性心肌梗死",急诊行冠状动脉造影抽吸右冠状动脉血栓,行球囊扩张并植入支架1枚,术后应用阿司匹林及氯吡格雷抗血小板治疗,单硝酸异山梨酯扩张冠脉。支架术后患者偶有夜间喘憋,伴有糖尿病酮症,对症处理后好转。10 d前外科提请多学科会诊拟行颈椎手术,考虑患者心肌梗死心功能恢复需4~6周,经皮冠状动脉介入治疗(PCI)术后再内皮化需6个月,不建议行择期手术。8 d前再次因胸痛于左冠状动脉回旋支近端、远端及右冠状动脉近端放置3枚支架,术后症状改善,BNP 797 pg/ml。2 d前新发右侧肩肘部肌力下降,呼吸急促,腹式呼吸消失,再次提请多学科会诊,拟在全身麻醉下行颈椎翻修术。

关 键 词：急性心肌梗死 翻修术 病史摘要 右冠状动脉 颈椎手术 术后症状 胸疼 单硝酸异山梨酯 

分 类 号：R614[医药卫生—麻醉学]