对严重心力衰竭的蛛网膜下腔出血患者成功施用克拉索坦。

Surgical neurology international Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI:10.25259/SNI_554_2024
Fuga Ayabe, Tomoyuki Kino, Tomo Kinoshita, Kana Sawada, Kuniyasu Saigusa
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引用次数: 0

摘要

研究背景氯唑生坦是一种内皮素受体拮抗剂,已被证明能有效预防蛛网膜下腔出血(SAH)后的脑血管痉挛。然而,克拉生坦引起的肺水肿是经常报告的不良反应,也是中断治疗的主要原因。患有先心病的患者容易出现严重的肺水肿,因此一般禁用克拉索坦:我们报告了一名患有 SAH 和严重心力衰竭(Takotsubo 心肌病)的 58 岁女性患者成功使用克拉索坦的病例。患者最初因左颈内后交通动脉瘤破裂导致 SAH。她成功地接受了颈部剪切术,术后开始了包括克拉生坦在内的预防脑血管痉挛的治疗。紧急手术干预后,她出现了肺水肿和弥漫性左心室运动功能减退,射血分数为 10-20%。虽然在服用克拉索坦后出现了药物诱发的肺水肿,但根据每日心功能和肺水肿时的呼吸机管理情况进行了有针对性的液体管理,从而完成了为期两周的克拉索坦治疗方案。这种方法保证了患者在整个治疗期间的病情稳定。结论:本病例强调了综合治疗的重要性:本病例强调了多学科方法在管理接受克拉索坦治疗的患有严重心脏并发症的复杂患者中的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Successful administration of clazosentan in subarachnoid hemorrhage patient with severe heart failure.

Background: Clazosentan, an endothelin receptor antagonist, has been shown to prevent cerebral vasospasms following subarachnoid hemorrhage (SAH) effectively. However, clazosentan-induced pulmonary edema is a frequently reported adverse effect and a primary reason for discontinuing treatment. The presence of preexisting heart conditions predisposes patients to severe pulmonary edema; thus, the administration of clazosentan is generally contraindicated.

Case description: We report the successful administration of clazosentan in a 58-year-old female patient with SAH and severe heart failure (Takotsubo cardiomyopathy). The patient initially presented with a ruptured left internal carotid posterior communicating artery aneurysm, leading to SAH. She successfully underwent neck clipping, and postoperative treatment to prevent cerebral vasospasm, including clazosentan, was initiated. Following the emergency surgical intervention, she exhibited pulmonary edema and diffused left ventricular hypokinesis with an ejection fraction of 10-20%. Although drug-induced pulmonary edema emerged after the administration of clazosentan, tailored fluid management based on daily cardiac function and ventilator management in response to pulmonary edema enabled the completion of a 2-week clazosentan therapy regimen. This approach guaranteed the patient's stability throughout the treatment period. Neither cerebral vasospasm nor cardiopulmonary complications were observed.

Conclusion: This case highlights the importance of a multidisciplinary approach in managing complex patients with severe cardiac comorbidities undergoing clazosentan therapy.

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