肺動脈高壓病患接受股骨頸骨折手術的成功圍術期止

Successful peri-operative pain management in a pulmonary hypertension patient undergoing femoral neck fracture surgery

肺動脈高壓是廣為人知的危險因子，使病人在手術期間容易發生併發症與死亡，也可能導致術後猝死。髖骨骨折手術患者多為合併多項疾病的老人，亦屬高風險手術也是一個術中術後併發症相當多的一個手術。這裡我們報告一位66歲女性，因股骨頸骨折要接受半人工髖關節置換手術，病患有慢性阻塞性肺部疾病和第二型糖尿病，音波發現了嚴重的肺動脈高壓。我們使用超音波來施行骼筋膜阻斷以輔助硬膜外半身麻醉，術中麻醉效果足夠、生命徵象穩定、術後止痛效果良好。手術後病人移送至加護病房接受照護，並且恢復良好、沒有發生術後合併症。經由此案例可知，肺高壓的病患如欲進行髖骨頸手術，髂筋膜阻斷術除了可提供手要超麻術周期良好的止痛外，亦可搭配半身麻醉來達到良好的麻醉效果並維持穩定的血液動力狀態。

Pulmonary hypertension is a well-known risk for perioperative mortality and morbidity and may induce sudden postoperative death. Hip fracture surgery is also considered as a high-risk operation because patients requiring such surgery are usually elderly with multiple comorbidities. Herein, we present a 66-year-old woman who suffered from right femoral neck fracture and underwent bipolar arthroplasty. Her underlying diseases included chronic obstructive pulmonary disease and diabetes. Preoperative echocardiography showed pulmonary hypertension. Ultrasound-guided fascia iliaca block was performed followed by epidural anesthesia. Adequate anesthesia, stable intraoperative hemodynamics and well postoperative pain management were achieved by combination of two techniques, then she was transferred to the intensive care unit and no postoperative adverse event was observed. The case suggests that fascia iliaca block might be considered for perioperative analgesia for the management of patients with pulmonary hypertension and femoral neck fracture. FICB could also be used as an adjuvant to epidural anesthesia for both excellent block quality and hemodynamic stability.