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本公眾號每天分享一篇最新一期Anesthesia & Analgesia等SCI雜志的摘要翻譯，敬請關(guān)注并提出寶貴意見 Sevoflurane prolonged the QTc interval and increased transmural dispersion of repolarization in a patient with long QT syndrome 3: a case report 背景與目的 先天性長QT綜合征（LQTS）是一種以心電圖（ECG）上QT間期延長為特征的遺傳性疾病，可導(dǎo)致致死性心律失常，如尖端扭轉(zhuǎn)型室速（TdP）、室顫（VF）和心源性猝死。迄今為止，據(jù)報(bào)道至少有15種不同的基因與LQTS相關(guān)。 方 法 我們報(bào)道了七氟醚不僅可引起長QT綜合征3型(LQT3)患者的QTc間期延長，還可增加跨室壁復(fù)極離散度。一名16歲的LQT3男性患者接受肩部手術(shù)，未發(fā)生暈厥、心跳驟停，但術(shù)前心電圖（ECG）顯示明顯的QTc間期延長（631ms）及Tp-e間期延長（126ms）。麻醉采用丙泊酚誘導(dǎo)，2%七氟醚和瑞芬太尼維持。 結(jié) 果 盡管圍手術(shù)期沒有發(fā)生致死性心律失常，但七氟醚不僅可以延長QTc間期，而且還可以延長Tp-e間期。盡管認(rèn)為七氟醚在QT間期延長方面是一種安全的麻醉藥，但對長QT綜合征患者，我們認(rèn)為對于控制不良的LQT3型患者應(yīng)避免使用七氟醚。 結(jié) 論 七氟醚仍是適用于長QT綜合癥患者的一種安全的麻醉藥，但對于QTc和/或Tp-e間期延長的LQT3患者還是存在致TdP和致死性心律失常的風(fēng)險。 原始文獻(xiàn)摘要 Kitaura A, Nakao S, Hamasaki S, et al. Sevoflurane prolonged the QTc interval and increased transmural dispersion of repolarization in a patient with long QT syndrome 3: a case report:[J]. Ja Clinical Reports, 2017, 3(1):29. Abstract:We report that sevoflurane not only caused marked QTc interval prolongation but also increased transmural dispersion of repolarization in a patient with long QT syndrome 3 (LQT3). A 16-year-old male with LQT3 underwent a shoulder operation. He experienced no episode of syncope or cardiac arrest, but his preoperative electrocardiography (ECG) showed marked QTc interval prolongation (631 ms) and Tp-e interval prolongation (126 ms). Anesthesia was induced with propofol and maintained with 2% sevoflurane and remifentanil. Although no lethal arrhythmias occurred in the perioperative period, not only the QTc interval but also Tp-e interval was further prolonged by sevoflurane. While sevoflurane has been recognized as a safe anesthetic in terms of QT interval prolongation, even in patients with long QT syndromes, we believe that sevoflurane might be avoided for poorly controlled LQT3 patients. 麻醉學(xué)文獻(xiàn)進(jìn)展分享 聯(lián)系我們 |
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