術前からの降圧鎮静により右脳灌流障害が顕在化した急性大動脈解離の1症例

Acute Aortic Dissection with Right-sided Cerebral Perfusion Defect Accentuated by Preoperative Antihypertensive Therapy and Sedation：A Case Report

要旨

　救急外来での降圧と鎮静を契機に右側脳灌流障害が顕在化した急性大動脈解離症例を報告する。手術室入室後の近赤外分光法による局所脳酸素飽和度の左右差は著明であり，両腋窩動脈送血による人工心肺開始後，右総頸動脈の血流は再開し，人工血管置換後，局所脳酸素飽和度の左右差は改善した。術後は明らかな脳障害なく経過した。

　We describe the case of a 52-year-old man patient with acute aortic dissection with prominent right-sided cerebral perfusion that was identified after he underwent antihypertensive therapy and sedation in the emergency room. The left-right difference in the patient’s regional cerebral oxygen saturation measured by near-infrared spectroscopy in the operating room was significant. After cardiopulmonary bypass with axillary artery perfusion was initiated, blood flow to the right common carotid artery resumed. The left-right difference in regional cerebral oxygen saturation improved after artificial blood vessel replacement. The postoperative course was uneventful, with no sequelae.