脑动脉瘤术后交感风暴一例

Postoperative sympathetic storm in a cerebral aneurysm patient:case report

交感风暴是神经重症患者诊治的难点之一。本文报道1例73岁女性患者,因后循环动脉瘤破裂行择期开颅动脉瘤夹闭术,术后出现交感风暴。患者于术后第3天出现血氧饱和度下降,伴大量稀薄水性痰,头颅CT发现小脑半球缺血及间质性肺水肿,序贯经过机械通气、镇痛镇静、β受体阻滞剂、血管活性药物应用、个体化液体管理等治疗后,患者好转出院。本例患者诊疗过程及结果提示,早期识别交感风暴,并给予积极的生命支持治疗,可望取得良好的预后。神经源性肺水肿和神经源性应激性心肌病是交感风暴常见表现形式,早期诊断并采取有效的治疗,可缩短病程,改善预后,降低病死率。

Sympathetic storm is one of the difficulties when managing severe neurological patients.We reported a 73-year-old female patient who underwent selective craniotomy and aneurysm clipping procedure after rupture of posterior circulation aneurysm,who suffered from sympathetic storm after the operation.On the third post-operative day,the patient presented a deterioration in pulse oxygen saturation,accompanied by a large amount of watery sputum.Computerized tomography(CT)revealed cerebellar hemisphere ischemia and interstitial pulmonary edema.When treated with mechanical ventilation,analgesia and sedation,beta receptor blocker application and individualized fluid management,the patient got better and was finally discharged.The experience in this patient suggests that early identification of sympathetic storm and optimal organ support are necessary to achieve a good prognosis.Neurogenic pulmonary edema and neurogenic stress cardiomyopathy are common complications of sympathetic storm.Early diagnosis and effective treatment can shorten the progress,improve prognosis and reduce mortality.