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供体肾切除术通常是比较安全和平稳,本文报道一例在全麻下行移植肾切除时因触及肾上腺而出现严重高血压,室性心动过速和心内膜F缺血.病人系一50岁男性,自愿提供活体肾移植,术前检查正常,无其它疾病.血压136/88 mmHg,心率72次/分,胸片和12导联心电网均未见异常.全麻用硫苯妥钠350 mg,潘可朗宁0.1mg/kg诱导,麻醉以笑气和氧气(60:40)维持,静脉镇痛新30mg同时吸入0.5%氟烷,游离肾上腺时,血压由130/80 mmHg突然增至260/140 mmHg,窦性心律变为室性心动过速,经停吸氟烷和静滴利多卡因2 mg/kg后,恢复窦性心律80次/分,血压仍为200/100mmHg,心电图表明有严重的心内膜下缺血,并静滴0.5 mg/kg·min硝酸甘油,3分钟后血压降至120/90 mmHg,心电图30分钟后恢复正常.然后继续进行手术和麻醉,术后恢复较平稳.血标本测定去甲肾上腺素浓度升高(16.5nmol/L),肾上腺素(300 pmol/L)浓度轻度增高,术后检查未发现嗜络细胞瘤征象.术后12和24小时血浆儿茶酚胺浓度正常,24和48小时尿标本显示总的非结合儿茶酚胺、2烯苯乙醇酸和总的3甲氧基肾上腺素基础水平正常.
Donor nephrectomy is usually relatively safe and stable, this article reports a case of grafting under general anesthesia due to hitting the adrenal gland occurs severe hypertension, ventricular tachycardia and endocardial F ischemia. The patient is a 50-year-old Male, voluntary living donor kidney transplantation, preoperative examination was normal, no other diseases, blood pressure 136/88 mmHg, heart rate 72 beats / min, chest X-ray and 12-lead ECG were no abnormal general anesthesia with 350 mg, Panclorin 0.1 mg / kg, anesthesia was maintained with noxiousness and oxygen (60:40), intravenous analgesia with a new 30 mg inhalation of 0.5% halothane, and free adrenal pressure was suddenly increased from 130/80 mmHg 260/140 mmHg, sinus rhythm into ventricular tachycardia, after stopping inhalation of halothane and intravenous lidocaine 2 mg / kg, the recovery of sinus rhythm 80 beats / min, blood pressure is still 200 / 100mmHg, electrocardiogram Showed severe subendocardial ischemia, and intravenous infusion of nitroglycerin 0.5 mg / kg · min, blood pressure dropped to 120/90 mmHg after 3 minutes, electrocardiogram returned to normal after 30 minutes, and then continued surgery and anesthesia, postoperative Recovery was relatively stable.The serum norepinephrine concentration (16.5nmol / L), epinephrine (300 pmol / L) concentration was slightly increased, postoperative examination did not Found signs of neutrocytoma at 12 and 24 hours after the plasma concentrations of catecholamines normal, 24 and 48 hours of urinary specimens showed total non-conjugated catecholamines, 2-hydroxybenzene acid and total 3-methoxy-adrenaline normal levels.