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題名 | Ulnar, Median, and Radial Neuropathies after Coronary Artery Bypass Surgery: A Case Report=冠狀動脈繞道手術後發生尺神經、正中神經及橈神經病變:病例報告 |
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作者姓名(中文) | 蘇王麟; 許嘉佑; | 書刊名 | 臺灣復健醫學雜誌 |
卷期 | 39:2 2011.06[民100.06] |
頁次 | 頁111-116 |
分類號 | 415.831 |
關鍵詞 | 神經病變; 心臟手術; 電學診斷; 麻醉; 併發症; Neuropathy; Cardiac surgery; Electrodiagnosis; Anesthesia; Complications; |
語文 | 英文(English) |
中文摘要 | 在過去,心臟手術(cardiac surgery)後的周邊神經病變(peripheral neuropathy)常被歸因於手術過程,例如胸骨拉回(sternal retraction)以及內乳動脈剝離術(internal mammary artery dissection)等,傷及解剖位置接近的神經所造成。常被報告的神經包括臂神經叢、膈神經、尺神經、喉返神經、隱神經以及交感神經鏈。 本病例報告一名54歲男性,在接受心臟不停跳(off-pump)冠狀動脈繞道手術後,呈現左手無力,經神經傳導及肌電圖檢查顯示,左側尺神經、正中神經及橈神經有不完全性損傷,病灶定位在左側上臂遠端。依解剖位置觀點,此病例應非導因於手術操作過程,而最可能是因測量血壓時加壓於上臂造成三條神經缺血性損傷。 雖然冠狀動脈繞道手術後造成上肢的周邊神經病變以臂神經叢受損爲最多,但若無詳細的電學診斷檢查,上臂三條神經同時受損,有可能被誤診爲臂神經叢損傷,特別是在心臟手術後。臨床上若遇有心臟手術後上肢無力或麻木,同時伴有糖尿病或其他會影響血液動力疾病的病人,應考慮安排電學診斷檢查以確定病灶位置。我們希望將來進一步研究,以找出可能的解決方案,避免同樣的併發症再度發生。 |
英文摘要 | Peripheral neuropathies after cardiac surgery are usually attributed to manipulation during the surgical procedure itself. A 54-year-old man developed left ulnar, median, and radial neuropathies after off-pump coronary artery bypass surgery. An electrodiagnostic study indicated a lesion located in the distal part of the upper arm. In view of the anatomy, this patient most likely developed neuropathy associated with intraoperative blood pressure monitoring. Iatrogenic peripheral neuropathy after cardiac surgery should be carefully assessed to find the exact cause. |
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