Ephedrine和Atropine治療無效的低血壓及心搏過慢：一個嚴重自主神經失調合併異常心律變異度的病例

Bradycardia and Hypotension Refractory to Ephedrine and Atropine Treatment: Severe Autonomic Dysfunction with Abnormal Heart Rate Variability

糖尿病患者合併自主神經失調有其潛在的麻醉風險，所以在手術當中或手術後是需要特別注意的。我們報告一位四十八歲男性的糖尿病患者在術中及術後發生心搏過慢及低血壓並且對ephedrine和atropine的治療無效，最後造成心跳停止，事後檢查心律變異性才發現病患有嚴重的自主神經失調，本文將針對可能引發的機轉及麻醉的考量作深入的探討。

Diabetic patients with autonomic dysfunction are potentially poor risks for anesthesia and particular care is needed during and after surgery. We here report a 48-year-old male patient with diabetes mellitus who suffered from intraoperative hypotension and bradycardia which did not respond to ephedrine and atropine treatment and eventuated in cardiac arrest. A heart rate variability study confirmed the diagnosis of autonomic dysfunction after the event. Possible predisposing mechanisms and anesthetic considerations are discussed.