老年肥胖患者术后再度镇静1例及文献复习

Anticoagulant Therapy for Pulmonary Embolism Post-Partial Nephrectomy: A Case Report and Literature Review

摘要: 病史摘要：本病例报道一例老年女性患者，入院诊断为“右侧输尿管肿瘤”，接受了“腹腔镜下右肾、输尿管及部分膀胱切除术”。术后发生了再度镇静。症状体征：手术结束后，患者在手术室内已恢复意识，自主呼吸良好，配合度高，符合拔管条件，遂予以拔管，随后送至麻醉恢复室(Post-Anesthesia Care Unit, PACU)。然而，进入PACU约十分钟后，患者再次出现意识消失，处于昏睡状态，对一般刺激无反应，考虑发生了再度镇静。诊断方法：患者在手术结束后经评估后拔除气管导管，但进入PACU后意识恢复差，Ramsay镇静评分为5分。在PACU观察125分钟后，患者意识才完全恢复，能够对外界言语刺激做出正确反应。临床转归：这是一例老年肥胖患者，在“腹腔镜下右肾、输尿管及部分膀胱切除术”拔管后出现了再度镇静的病例。经过积极地监护和处理，患者预后良好。

Abstract: Case Summary: This case report describes an elderly female patient diagnosed with a “right ureteral tumor” who underwent a “laparoscopic right nephroureterectomy and partial cystectomy”. Postoperatively, the patient experienced re-sedation. Signs and Symptoms: After the completion of surgery, the patient regained consciousness in the operating room, exhibited good spontaneous breathing, and showed high cooperation, meeting the criteria for extubation. She was subsequently transferred to the Post-Anesthesia Care Unit (PACU). However, approximately ten minutes after entering the PACU, the patient experienced a loss of consciousness, falling into a comatose state with no response to general stimuli, indicating re-sedation. Diagnostic Methods: Postoperatively, the patient was assessed and extubated in the operating room. Upon transferring to the PACU, her level of consciousness deteriorated, with a Ramsay Sedation Score of 5. After 125 minutes of observation in the PACU, the patient’s consciousness fully recovered, and she was able to respond appropriately to verbal stimuli. Clinical Outcome: This case involves an elderly obese patient who experienced re-sedation following extubation after a “laparoscopic right nephroureterectomy and partial cystectomy”. Through active monitoring and intervention, the patient had a favorable prognosis.