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相關文獻
- Blow-out Fracture with Oculocardiac Reflex Induced Bradycardia
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題名 | Blow-out Fracture with Oculocardiac Reflex Induced Bradycardia=創傷性眼窩底骨折合併心律過緩 |
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作者 | 陸尊惠; 顏毓秀; 吳瑞星; 蒲啟明; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 20:1 2011.03[民100.03] |
頁次 | 頁79-85 |
分類號 | 416.75 |
關鍵詞 | 眼球心臟反射; 眼窩底骨折; 心律過緩; Oculocardiac reflex; Blow-out fracture; Orbital floor fracture; Bradycardia; |
語文 | 英文(English) |
中文摘要 | 背景:眼球心臟反射是因爲牽扯眼球周圍組織或眼球壓迫而導致的心跳減緩。這個又名爲Aschner現象的反射常造成緩脈、噁心和昏厥三個症狀。雖然眼窩底骨折引起的眼球心臟反射不常見,但是立即的診斷和治療很重要。目標及主旨:本報告目的在提醒如果這個現象沒有被發現或治療,將可能造成極嚴重的後遺症。材料及方法:我們報告一個因爲車禍而受到臉部和胸部頓傷的二十歲男性患者。一開始的頭部電腦斷層掃描和胸部X光沒有特別的發現。到達我們醫院的時候,患者開始報告噁心、複視和臉部麻木感。身體理學檢查和心腦圖發現竇性緩脈(心跳每分鐘40下)。電腦斷層掃描此時發現左眼窩底骨折、眼窩脂肪突出至上頷竇和下直肌拉長。結果:經診斷爲眼窩底骨折和眼外肌陷入造成的眼球心臟反射,患者接受緊急手術。術中發現有眼窩脂肪突出和下直肌拉長。手術復位突出的部分並以鈦合金網狀板修補。術後患者恢復良好,心跳也回到竇性心律(每分鐘60至80次)。術後第五天患者順利出院。結論:眼外肌陷入可能刺激眼球心臟反射,引起緩脈和噁心嘔吐。這個反射現象是由於三叉神經和副交感神經的迷走神經的聯結所造成。新生兒和兒童對於這個反射特別敏感,但也可能發生於成年人。這個反射會造成緩脈、房室交接處節律、心跳停止或罕見的死亡。因此及時的骨折復位和放鬆陷入的眼外肌可以使患者免於因眼球組織嵌箝造成的缺氧傷害和可能造成致命心律不整的眼球心臟反射。手術中與麻醉科的配合也是手術成功的重要因素。 |
英文摘要 | Background: The oculocardiac reflex is a decrease in pulse rate associated with tractional force applied to the extraocular muscles or compression of the eyeball. This reflex, also known as the Aschner phenomenon, induces a triad of bradycardia, nausea, and syncope. The association of oculocardiac reflex with orbital fracture is rare, but prompt diagnosis and treatment are important. Aim and Objectives: Our purpose is to share our experience of this rare phenomenon and to bring awareness to the possibility of devastating morbidity if the condition is unrecognized or untreated. Materials and Methods: We report a 20-year-old male patient who sustained facial and chest contusion injuries as the result of a motor vehicle accident. Initial brain computed tomography and plain chest X-ray showed negative findings. On presentation at our institution, patient reported nausea, diplopia and facial numbness. Physical examination and electrocardiogram revealed sinus bradycardia of 40 beats per minute. Computed tomography revealed left orbital floor blowout fracture and herniation of orbital fat into the maxillary sinus and elongation of the inferior rectus muscle. Results: Under the impression of orbital floor blowout fracture with oculocardiac reflex induced by entrapment of extraocular muscle, emergent surgical intervention was carried out. During surgery, herniation of orbital fat with entrapment of the inferior rectus muscle was confirmed. Herniated contents were reduced and the defect was repaired with a titanium mesh plate. The patient recovered from surgery uneventfully and his heart rate reverted from 40 beats per minute to sinus rhythm (60-80 beats/min) postoperatively. He was discharged from the hospital on the fifth postoperative day. Conclusion: Entrapment of extraocular muscles can stimulate the oculocardiac reflex, producing bradycardia, as well as nausea and vomiting. The reflex is mediated by nerve connections between the trigeminal cranial nerve and the vagus nerve of the parasympathetic nervous system. This reflex is especially sensitive in neonates and children, but may also occur in adult patients. Bradycardia, junctional rhythm, asystole, and very rarely death, can be induced through this reflex. Therefore, timely fracture reduction and release of the entrapped extraocular muscles will protect patients from ischemic injury to incarcerated orbital soft tissue and development of oculocardiac reflex that may result in fatal cardiac arrhythmia. |
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