不同临床结局Brugada综合征2例的麻醉探讨  

Anesthesia exploration in 2 cases of Brugada syndrome with different clinical outcomes

作　　者：李琪 曹阳 王琳 何淑英 LI Qi;CAO Yang;WANG Lin;HE Shuying(Department of Anesthesia,Guizhou Medical University,Guiyang,Guizhou 550000,China;Department of Anesthesiology,Guangzhou Red Cross Hospital,Guangzhou,Guangdong 510000,China)

机构地区：[1]贵州医科大学麻醉系,贵州贵阳550000 [2]广州市红十字会医院麻醉科,广东广州510000

出　　处：《安徽医药》2024年第4期782-785,共4页Anhui Medical and Pharmaceutical Journal

基　　金：广州市科技计划项目(202103000022)。

摘　　要：目的 探讨2例不同临床结局Brugada综合征的围术期麻醉要点。方法 对2015年7月至2016年7月、2022年3—5月广州市红十字会医院收集到的2例不同临床结局Brugada综合征的麻醉病例进行分析总结。结果 1例72岁的Brugada病人,有多次晕厥病史,于2013年植入心律转复除颤器(ICD),植入ICD后晕厥症状消失,其后,因“下肢静脉曲张”与“腹股沟疝气”在全身麻醉下行手术治疗,2次围手术期均未出现恶性心律失常不良事件。而另1例Brugada病人,则是因“躯干、下肢烧伤”在全身麻醉下进行了清创植皮术,但在手术之前,并没有植入ICD。与前1例病人不同,该病人在2次围手术期均发生了恶性心律失常事件,并且在随访的1年内死亡。结论 许多围手术期的药理学因素及非药理因素均可能诱发Brugada综合征病人恶性心律失常事件的发生,而术前植入起搏器也许可以降低这种风险,ICD是保证围手术期安全的重要保障。Objective To explore the key points of perioperative anesthesia in 2 cases with different clinical outcomes of Brugada syndrome.Methods Two anesthesia cases with different clinical outcomes of Brugada syndrome in Guangzhou Red Cross Hospital from July 2015 to July 2016 and March to May 2022 were analyzed and summarized.Results A 72-year-old Brugada patient with a history of multiple syncope was implanted with a cardioverter defibrillator(ICD)in 2013,and the syncope symptoms disappeared after the implantation of the ICD,during which varicose veins of the lower limbs and inguinal hernia were treated under general anesthesia.No adverse events of malignant arrhythmia occurred during the perioperative period.The other Brugada patient underwent debridement and skin grafting under general anesthesia for"burns to the trunk and lower extremities"without implantation of an implantable cardio-verter-defibrillator(ICD)before surgery.Unlike the previous patient,this patient experienced malignant arrhythmic events during both perioperative periods and died within 1 year of follow-up.Conclusion Many perioperative pharmacologic and nonpharmacologic fac-tors may predispose to the occurrence of malignant arrhythmic events in patients with Brugada syndrome,whereas preoperative implan-tation of a pacemaker may reduce this risk,and an ICD is an important safeguard for perioperative safety.

关 键 词：BRUGADA综合征 心律失常 除颤器 植入型 麻醉 围手术期 

分 类 号：R614[医药卫生—麻醉学]