垂体瘤术后再麻醉后心脏骤停合并心肌梗死个案报道1例

One Case of Cardiac Arrest Combined with Myocardial Infarction after Reanesthesia for Pituitary Tumor

垂体腺瘤是最常见的神经内分泌腺瘤,来源于腺垂体,该病约占颅内肿瘤的10%~15%,人群中垂体腺瘤患病率约为1.5%~26.7%。多数垂体腺瘤首选手术治疗,神经内镜下经鼻蝶垂体腺瘤切除手术是垂体腺瘤首选的手术方式,该术式肿瘤全切率较高(96.67%),手术创伤较小,术中出血量少,手术时间短,患者术后并发症发生率低,是一种安全、有效的治疗方案。该术式术后并发症主要为暂时性尿崩、垂体功能下降、鼻黏膜出血、脑脊液鼻漏等。心脏骤停是一种临床工作中较为常见急危重症,是由多种因素导致的心脏射血功能突然终止,全身血液流通受阻,导致机体器官、功能出现重度缺血、缺氧、代谢障碍等症状,患者死亡率较高。早期快速准确的识别判断、及时有效的启动高质量的CPR,正确使用体外除颤器、尽早开辟静脉通道及合理使用抢救药物,显著改善了心脏骤停幸存者的生存率和长期预后。急性心衰、心肌梗死等是心脏骤停后较为严重的并发症,针对患者心脏骤停后出现的急性心衰及心肌梗死予以有效的预防、及时的诊断及治疗是重中之重。本案例旨在通过对患者垂体瘤术后再麻醉出现心脏骤停及心肌梗死情况的经过及处理的报道,探索行之有效的预防及解决方案,优化诊疗过程,避免此类事件发生,提高救治率。

Pituitary adenoma is the most common neuroendocrine adenoma. It originates from the adenohy-pophysis and accounts for about 10%~15% of intracranial tumors. The prevalence of pituitary ad-enoma in the population is about 1.5%~26.7%. Surgical treatment is the first choice for most pitui-tary adenomas. Transnasal transsphenoidal pituitary adenoma resection under neuroendoscope is the first choice for pituitary adenomas. This operation has a high total tumor resection rate (96.67%), less surgical trauma, less intraoperative bleeding, short operation time and low inci-dence of postoperative complications. It is a safe and effective treatment scheme. The main postop-erative complications were temporary diabetes insipidus, pituitary function decline, nasal mucosal bleeding, cerebrospinal fluid rhinorrhea and so on. Cardiac arrest is a common acute, critical and severe disease in clinical work. It is the sudden termination of cardiac ejection function and ob-struction of systemic blood circulation caused by many factors, resulting in severe ischemia, hypox-ia, metabolic disorder and other symptoms of body organs and functions, and the patient mortality is high. Early rapid and accurate identification and judgment, timely and effective start of high-quality CPR, correct use of external defibrillator, early opening of venous channel and rational use of rescue drugs have significantly improved the survival rate and long-term prognosis of cardiac arrest survivors. Acute heart failure and myocardial infarction are more serious complications after cardiac arrest. The most important thing is to effectively prevent, timely diagnose and treat the pa-tients with acute heart failure and myocardial infarction after cardiac arrest. The purpose of this case is to explore effective prevention and solutions, optimize the diagnosis and treatment process, avoid such events and improve the treatment rate through the report on the process and treatment of cardiac arrest and myocardial infarction after postoperative anesthesia of pituitary adenoma.