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題名 | Hypovolemic Shock Induced by Laparoscopic Cholecystectomy--A Case Report=腹腔鏡膽囊摘除手術時因不當穿刺傷害引起低容積性休克之病例報告 |
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作者 | 曾元宏; 何謂明; 洪維德; | 書刊名 | 麻醉學雜誌 |
卷期 | 35:4 1997.12[民86.12] |
頁次 | 頁247-252 |
分類號 | 416.5 |
關鍵詞 | 膽囊摘除術:腹腔鏡; 併發症:低容積性休克; Cholecystectomy:Laparoscopic; Complication:Hypovolemic shock; |
語文 | 英文(English) |
中文摘要 | 以腹腔鏡執行膽囊摘除手術,在臺灣已經有越來越普遍的趨勢,一般民眾對這種 方式手術的接受程度也頗佳,甚至在一些中型醫院也都有在執行這一類的手術。本病例是一 位男性,身高168公分,體重50.5公斤,在接受腹腔鏡膽囊摘除手術時,因第一只腹腔鏡套 管(trocar)穿刺不當,傷害到腹主動脈,導致休克。在手術中,從發現休克到改行剖腹探查止 血的過程約為二十分鐘,這段時間內出血超過3,000西西,血壓在快速輸給代用血漿1,000 西西的情況下,仍然只能維持在40/18至60/20毫米汞柱之間。經剖腹探查,發現在腹主動脈 上方有一個長約1公分的傷口。待完成修補此傷口並病患的情況穩定之後,外科醫師完成原定 之膽囊摘除手術。總計至手術完成時,出血量為7,300西西,尿液1,300西西,共給予輸液: 濃縮紅血球24單位,新鮮冷凍血漿12單位,血小板12單位。手術完成後,病患被送到外科 加護病房中觀察。經過24小時後,血壓仍舊無法穩定維持。同時發現尿液明顯減少,並且在 病患陰囊和雙側下肢出現水腫的現象。病患被送到外科加護病房後的第44小時,病患發生心 臟衰竭。經急救兩個小時無效後,宣佈不治死亡。研判死因是後腹膜的出血未能被有效控制, 導致腎動脈受到壓迫,腎臟灌流不足,以至於發生急性腎衰竭,進而誘發血液動力代償失敗。 |
英文摘要 | Since its introduction and development in the 1960s, laparoscopic cholecystectomy has become widely accepted by the medical community and the public as the treatment of choice for various gallbladder disorders. We present a 46-year-old male who underwent laparoscopic chlecystectomy, during which inadvertent penetration of the first trocar resulted in injury of the abdominal aorta and then hypovolemic shock ensured. The time from notification of shock by the anesthesiologist to swith of procedure to exploratory laparotomy for stanching hemorrhage was twenty minutes. During the intervention, blood loss was over 3,000 ml and despite rapid infusion of plasma expander, blood pressure could only be maintained between 40/18 to 60/20 mmHg. After the patient became stabilized and blood pressure was elevated to acceptable levels, conventional cholecystectomy was performed instead. Perioperative blood loss of 7,300 ml was estimated. In total, the patient received 24 units of packed red blood cells, 12 units of fresh frozen plasma, and 12 units of platelets. After the operation, the patient was transferred to the surgical ICU for further observation. For 24 h at the ICU, blood pressure remained unstable, urine output decreased gradually, and scrotal and leg edema developed. Forty-four h after admisson to the surgical ICU, arrhythmia and profound hypotension were noted and cardiac arrest ensued. After resuscitation for 2h, the patient could not be revived and succumbed to ardiovascular decompensation secondary to acute renal shutdown and continuous retroperitoneal hemorrhage. |
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