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題 名 | 冠狀動脈繞道手術後併發腦中風及脊髓梗塞:病例報告=Cerebral Stroke and Spinal Infarction after Coronary Artery Bypass Graft: A Case Report |
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作 者 | 許群昇; 林曉微; 蘇希洵; 吳淑娟; | 書刊名 | 臺灣復健醫學雜誌 |
卷 期 | 40:2 2012.06[民101.06] |
頁 次 | 頁109-116 |
分類號 | 416.262 |
關鍵詞 | 冠狀動脈繞道手術; 中風; 下肢癱瘓; 脊髓梗塞; Coronary artery bypass graft; Stroke; Paraplegia; Spinal infarction; |
語 文 | 中文(Chinese) |
中文摘要 | 冠狀動脈繞道手術(coronary artery bypass graft)後同時併發腦中風及脊髓梗塞相當罕見。術後梗塞性中風和手術中產生之血管栓塞有關,而術後脊髓梗塞和術中或術後脊髓灌流不足相關。除了患者本身具有心血管疾病史外,若是術中或術後有使用體外循環,亦是造成術後急性梗塞性腦中風或脊髓梗塞之危險因子,因而影響患者預後及增加住院時間。本篇案例報告為一位61歲男性,因冠心症接受冠狀動脈繞道手術,術中使用體外循環及接受長時間麻醉,術後造成右側肢體偏癱及雙下肢無力,為同時發生急性梗塞性腦中風及脊髓梗塞之症狀,脊髓梗塞位於前脊髓動脈灌流血液支配最少、易缺血之胸髓第四節至第九節處,病患在接受復健治療後,日常生活功能有進步但仍需依賴旁人協助。本文提供案例報告並討論冠狀動脈繞道手術後造成腦中風及脊髓梗塞的可能機制,另提供文獻回顧整理及討論。 |
英文摘要 | Cerebral stroke and spinal cord infarction are rare complications after coronary artery bypass graft (CABG). The coexistence of them in one case is extremely rare. Cerebral microemboli generated during CABG is connected to acute ischemic stroke. Spinal cord infarction after CABG is related to hypoperfusion of the spinal cord. Except for the cardiovascular disease, the use of cardiopulmonary bypass during or after surgery is also a risk factor for both of the complications. They are not only increase the length of hospital stay but also contribute to patient's poor prognosis.We reported a 61-year-old male, with histories of hypertension, type II diabetes mellitus and coronary artery disease, referred to the cardiovascular surgeon for CABG due to acute coronary syndrome. He received cardiopulmonary bypass and prolonged anesthesia. However, triplegia developed thereafter which implicated the occurrence of both cerebral stroke and spinal cord infarction. He had T4 imcomplete paraplegia which is compatible with the watershed area from T4 to T9. This area is known for the vulnerability to hypoperfusion. After rehabilitation programs, the patient recovered only partially. In this article, the possible mechanisms of cerebral stroke and spinal cord infarction are discussed and the relevant literature is reviewed. |
本系統中英文摘要資訊取自各篇刊載內容。