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題 名 | Fatal Hyperkalemia during Rapid and Massive Blood Transfusion in a Child Undergoing Hip Surgery--A Case Report=兒童於接受股骨術中因大量快速輸血導致致命性高血鉀--病例報告 |
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作 者 | 陳介絢; 洪健朗; 高宜娟; 李慧玲; 陳昶馗; 石明煌; | 書刊名 | 麻醉學雜誌 |
卷 期 | 37:3 1999.09[民88.09] |
頁 次 | 頁163-166 |
分類號 | 415.652 |
關鍵詞 | 輸血; 休克; 心跳停止; Blood transfusion; Shock; Cardiac arrest; |
語 文 | 英文(English) |
中文摘要 | 高血鉀為輸血常見之併發症,本病例報告一病患因手術中大量快速輸血,導致致 命性高血鉀症。病患是一位體重約20公斤重的7歲小女孩,因罹患股骨頭惡性腫瘤,需進行 股骨切除及人工關節術。手術進行約4小時,期間失血快速,約達3,000mL,主要輸血為15 單位紅血球濃厚液。其後,由外病患仍處於低血壓及低血量狀態,開始輸注全血。不幸的是, 十分鐘之後(此時大約已輸入100mL全血)心電圖突然QRS變寬,隨後即心跳停止,急救無效。 心跳停止時的抽血發現,其血鉀濃度高達10.3mmol/L。此病例報告再度提醒我們,輸血血品 的重要性,特別是當病患為兒童,又處在低血量、低心博輸出量時,必須輸注含鉀離子少的 血品,例如新鮮或生理鹽水處理過之紅血球濃厚液。 |
英文摘要 | We report a girl who developed severe and fatal hyperkalemia following rapid and massive blood transfusion during surgery. She was 7-year-old, 20-kg in weight, and received wide resection of the femoral bone with custom prosthesis implant because of malignant femoral osteosarcoma. During the procedure, bleeding was active and profuse and amounted to about 3,000 mL in 4 h, eventuating in shock. Despite rapid transfusion with 15 units of packed red blood cells (RBC) still she remained hypotensive and hypovolemic. When we switched to give her whole blood, actually 100 mL having been given, widening of QRS complex followed immediately by cardiac arrest developed. Cardiopulmonary resuscitation although started at once was unsuccessful. At this juncture, arterial blood gas analysis showed acidosis and severe hyperkalemia (10.3 mmol/L), possibly resulting from transfusion of blood of older storage. The case reminded us once again the importance and necessity of the use of potassium-low blood component (fresh, saline-washed RBCs) in case of massive and rapid blood transfusion especially in pediatric patients with hypovolemia and low cardiac output |
本系統中英文摘要資訊取自各篇刊載內容。