第6章 Case Report.docVIP

Case Report A 33-year-old woman weighing 108 kg with obesity and neurofibromatosis was presented with a 2-year history of poorly controlled hypertension, headaches, palpitations, and occasional chest pain. Her blood pressure was 170/100mm Hg, and she was treated with daily oral dose of diltiazem (360 mg), hydrodiuril (12.5 mg), lisinopril (20 mg), and metoprolol XL (25 mg) tablets. 患者,女33岁,体重108公斤.肥胖和神经纤维瘤病，难以控制高血压2年，伴头痛，心悸，偶尔胸痛。她的血压是170 / 100毫米汞，每日口服 地尔硫卓（360毫克），二氢氯噻（12.5毫克），赖诺普利（20毫克），和美托洛尔加大码（25毫克）片控制血压。Biochemical evaluation for pheochromocytoma showed elevated 24-hour urine metanephrine levels of 5496 mcg and normetanephrine level of 6415 mcg. A computed tomographic scan of the abdomen showed a 6_6-cm right adrenal mass. The remainder of her preoperative tests was otherwise normal. 生化提示嗜铬细胞瘤,24小时尿肾上腺素水平5496微克和去甲肾上腺素水平的6415微克。腹部CT扫描发现了6_6-cm右肾上腺肿块。其余的术前检查正常。Three weeks before surgery, the patient was started on phenoxybenzamine of 10mg per day orally, which was gradually increased to 30mg 3 times a day. 在手术前三周，病人开始每天口服酚苄明从10 mg逐渐增加到30 mg，一天3次。The day before the planned surgery, the patient was admitted to surgical floor, her average blood pressure and heart rate were 134/76mm Hg and 65 bpm, respectively. At midnight, she was given an extra dose of 40mg of phenoxybenzamine and also received 1L of 5% dextrose with 0.45% normal saline. 术前一天，病人被送往外科楼, 她的平均血压134 / 76毫米汞，心率65次/分。在术前当晚，患者口服一个额外的40毫克酚苄明，并输注5%葡萄糖氯化钠注射液1000ml。The following morning patient was taken to the operating room, standard monitors were applied, and a radial arterial and central venous line was placed. 翌日早上病人被送到手术室，接标准监护仪，并桡动脉和中心静脉置管。Anesthesia was induced with intravenous propofol (200 mg), fentanyl (100 mcg), rocuronium (60 mg), and maintained with end-tidal sevoflurane 2.0% to 3.0% in 66% nitrous oxide and 34% oxygen. The patient was ventilated with 8 to 10 ml/kg tidal volume to maintain an end-tidal CO2 between 33 and 36mm Hg. The patient was positioned in a left lateral decubitus position an