在全身麻醉下使用腺甘酸所引起支氣管痙攣－－病例報告

Intraoperative Bronchospasm after Intravenous Adenosine during General Anesthesia

由於腺甘酸的作用快速且短效，使其在許多方面，包括心室上心搏過速及在藥物壓力測試上使冠狀動脈擴張等方面有其應用。但是腺甘酸的副作用包括了 ：呼吸困難、噁心、頭痛、胸痛、臉潮紅和支氣管痙攣。雖然有少數幾篇提及給予腺甘酸之後產生支氣管痙攣的病例報告，近年來有些研究卻顯示：在慢性阻塞性肺疾及氣喘的病人，腺甘酸並不是使用禁忌。我們描述一男性肺氣腫病人，在麻醉中因突發性心室上心搏過速而使用腺甘酸治療，卻引起了嚴重的支氣管痙攣。經過治療，病人在無併發症的情況下五天後出院。在此，我們回顧了相關文獻，及探討腺甘酸引起支氣管痙攣的機制和處理方法。

Adenosine with its rapid onset and brief duration of action has a number of clinical applications including treatment of paroxysmal supraventricular tachycardia and maximal coronary vasodilatation during pharmacologic stress testing. The adverse effects of adenosine include dyspnea, nausea, headache, chest pain, flushing and bronchospasam. Although there were few reports which mentioned the occurrence of bronchospam after administration of adenosine, a number of studies indicated that the use of adenosine was not contraindicated in patients with chronic obstructive pulmonary disease (COPD) or asthma. We report here a male patient with pulmonary emphysema and lung bullous disease who developed severe constriction of the main bronchi after intravenous adenosine during general anesthesia. After treatment, the patient was discharged without complications. We have reviewed the related current literature and herein discuss the reason and management of the adenosine induced bronchospasm.