1 case of limited cardiac pressure jam caused by cardiac encapsulation fluid during thoracic anesthesia awakening

1Patient informationpatients, female, 48 years old, height 158 cm, body mass 75 kg, due to "leftlung cancermore than 1 year, the third chemotherapy" hospital, no other special past history,diagnosis: left lung lower leaf adenocarcinomaAfter admission to the relevant preoperative examination results are normal, no surgical contraindications, in order to reduce the amount of narcotic drugs, provide a better analgesic and muscle relaxation environment, on March 20, 2017 in the selection of static smoking compound general anaesthetic and neuro-blocking anesthesialung cancertreatmentmonitoring of noninvasive blood pressure, heart rate (HR) and pulse oxygen saturation (SpO2) after entering the chamberBureau-hemp ultrasound directs the right intra-cervical venous puncture and retains a single cavity central venous catheter, and the right artery puncture tube in order to monitor the analysis of the blood of the artery after the invasive artery and the intermittent artery blood gasAfter the general anaesthetic induction, the left double cavity bronchial catheter is successfully inserted, and then the ultrasound guides the nerve block of the lower T5 and T7 thoracic vertebraeInoperative static absorption compound maintains anesthesia, and the patient's vital signs are stablepatients transferred to the anaesthetic recovery room (PACU) to wake up, after the extraction of the tube, successfully pulled out the double cavity trachea catheterThe patient's blood pressure (BP) suddenly dropped from about 150/85mmHg to about 70/40mmHg, and HR increased from 80 times/min to about 130 times/min Arterial blood gas tips PH7.193, arterial blood carbon dioxide pressure (PaCO2) 39.9mmHg, blood lactic acid (Lac) 6.74mmol/L, immediately infusion amber-yl gelatin supplementblood capacity Sodium bicarbonate to correct acid poisoning, multiple large quantities of dopamine (2mg/mL) and norepinephrine (80?g/mL) static injection to raise blood pressure, aerateing 40mg static anti-shock therapy, circulatory improvement is not obvious to observe the patient's shortness of breath, the call ability should be poor lying, the hearing lung breathing sound is normal, the heart tone is low, consider the heart pack fluid may, then give the high-sin 0.2mg slow static injection to improve myocardial contraction, Aisrol 20 mg static injection heart rate and other treatment, during which the intermittent giving multiple dopamine (2mg/mL) and no renosis (80 mg/mL) Please show the superior doctor after the emergency consultation, cardiac ultrasound found heart bag filling, a small amount of heart encapsulation fluid (blood), inform the patient's attending physician, and communicate with the family after pacu emergency heart bag puncture extraction of blood fluid about 6mL, the patient's biopics tend to level off, arterial blood gas valuereturn to normal, after the intensive care unit (ICU) continue to observe treatment patients after surgery to strengthen atomization sputum, nutrition, pain relief and support treatment, to Aislor control heart rate, the indicators tend to normal, vital signs gradually stable, did not appear the above symptoms, the 6th day after surgery successfully removed the chest drainage tube, recovery is good Postoperative pathology backindication: left lower lung - low differentiation adenocarcinoma, accompanied by scaly, pulmonary lymph nodes visible cancerous tissue 2 Discussion heart congestion is a common complication of intra-cardiac surgery, which can be caused by a variety of triggers, which is still rare during the resuscitation of chest surgery The normal heart cavity contains a small amount of liquid, when the liquid content of more than 50mL can be diagnosis as heart pack fluid Cardiac congestion is caused by excessive fluid accumulation in the heart envelope cavity clinical disease, because the amount of heart-packfluid and the formation rate exceeds the heart envelope expansion compensation capacity, resulting in limited cardiac diastolic period, clinical mainly manifested in the central venous pressure increase, sinus tachycardia, breathing difficulties, blood pressure drop, strange veins and other signs the classic heart congestion mainly according to the patient's clinical symptoms, signs, heart ultrasound, chest CT and other auxiliary examination quickly and clear diagnosis, in which the chest heart ultrasound with its portability, rapid and non-invasive in the diagnosis of heart encapsulation in the important position In clinical work, there is a kind of heart encapsulation fluid although the amount is not large, but because of the limitation of compression of important parts, and affect the heart function, leading to serious consequences, such heart-pack fluid is called limited heart encapsulation fluid, its resulting heart congestion is called limited heart congestion However, the limitation of cardiac congestion as an early postoperative complication of cardiology, a large number of data show that its fatality rate of up to 20%, mainly because of the limited heart-packfluid less and the location of the relatively limited, often lead to its ultrasound positive rate is low, resulting in patients can not get timely diagnosis and treatment Limitation heart plug is a special type of cardiac pressing plug, can occur in various parts of the heart, resulting in the corresponding chamber cavity pressure Limitation of cardiac congestion occurs even if only a certain atrium or ventricle is oppressed, but the heart as a whole movement, its play "pump" function depends on the normal operation of the four-heart cavity, body circulation, lung circulation, when any part of the function is impaired will affect the entire heart function changes, and thus lead to the disorder of hemodynamics of the whole body limited cardiac congestion causes patients with vital signs to be unstable and have severe hemodynamic disorders, it is necessary to perform emergency heart-pack puncture stabs to relieve heart congestion Heart-pack puncture is often the preferred method for clinicians because of its speed and ease of operation However, several clinical reports show that the heart-packing failure rate of limited cardiac congestion is often high, if necessary, can consider the line emergency heart bag window drainage surgery timely removal of blood clots or fluid, relieve heart congestion, improve hemodynamic disorder Complications during the whole hemp wake-up period in patients with thoracic surgery are restlessness, inadequate ventilation or post-tongue falls, sore throat or throat edema, throat spasms and nausea and vomiting, bleeding, etc the patient is a middle-aged elderly female lung tumor patient, the left lung lower loe lung cancer cure, during the awakening of serious limited cardiac congestion, manifested as sinus tachycardia, drug difficult to correct low blood pressure, breathing difficulties, etc , by thoracic ultrasound image Found strong echo flocs in the heart envelope cavity, and the attending physician and family after communication, emergency heart bag puncture pumping 6mL or so without clotting, the patient's vital signs improved, confirmed the patient's limitation of heart-packing this diagnosis The source of blood accumulation of heart pack may be surgically related heart-wrapped blood, but should still be distinguished with heart-packed fat pads, narrowing of cardiopulmonary inflammation, tumor-based hemorrhage heart-wrapped fluid, a large amount of thoracic fluid, and limited heart-wrapped fluid After operative follow-up patients met the change of the root treatment of lower left lung cancer, and then well Although the source of blood accumulation in the patient is still difficult to determine, but under the leadership of anesthesiologists, the active use of ultrasound-assisted diagnosis of clinically difficult cases, coupled with the clinician careful physical examination to accurately determine the condition after rapid treatment, so that the patient turned to safety, after surgery patients did not leave any complications, in the perioperative period is rare With the widespread use of ultrasound technology in the perisinal, intensive care, pain and , in the preoperative assessment, the diagnosis, monitoring of the heart, vascular surgery, regional anesthesia, postoperative analgesia and pain will provide more help to clinical anesthesiologists, reduce and avoid more unnecessary complications, improve preoperative assessment, inoperative monitoring and perioperative pain