经胸腔镜左心交感神经切除术治疗先天性长QT综合征的麻醉  

Anesthesia for Patients with Congenital Long QT Syndrome

作　　者：刘怡昭[1] 杨拔贤[1] 

机构地区：[1]北京大学人民医院麻醉科,北京100044

出　　处：《麻醉与监护论坛》2006年第5期253-254,共2页Forum of Anesthesia and Monitoring

摘　　要：先天性长QT综合征的特性心律失常为潦端扭转型室性心动过速（TdP）,对于β受体阻滞剂治疗无效的患者可行大左心交感神经切除术，我们为8例c-LQTS患者，经胸腔镜行左心交感神经切除术，成人6例，儿童2例。术前QT间期明显延长，术后都有明显缩短，其中3例已恢复正常，7例术后未再发作TdP，1例6岁儿童术后4个月复发，该儿童手术期间发生3次室性心动过速，应用利多卡因后恢复窦性心律，其他患者术中血压，心律平稳，如何预防和治疗致使性TdP，是围术期麻醉管理的重点，术前准备的重点是降低交感神经兴奋性，准备体外除颤装置，选择对CT间期影响小，可控性强的药物，维持适当麻醉深度，术后镇病和及时应用β-受体阻滞剂。Congenital long QT syndrome is an arrhythmic cardiovascular disorder resulting from mutatons in cardiac ion channels, which can lead to a characteristic polyrnorphic ventdcular tachycardia known as torsades de points （TdP） Patients with c-LQTS may be at increased risk of developing malignant TdP. In this retrospective study, perioperatve anesthesia management of 8 c-LQTS patients who received left cardiac sympathetic denervatien was reviewed. A E-year patient experienced ventricular tachycardia three times during the operation and treated successfully with lidecaine, while other patients had uneventful caurse of anesthesia. The prolonged QT intervals shorten after surgery in all 8 patients, in which 3 returned to normal. Seven of eight patients had no cardiac events happened after left cardiac sympathetic denervation. The recommendations and special consideration to prevent and manage perloperative TriP include prowding adequate p-blockade, defibrillator available, preventing excessive sympathetic activity, and using drugs wgh fewer effects on QT interval. Meanwhile. adequate pain control should be ensured and β-blockade should be maintained postoperatively.

关 键 词：先天性长QT综合征 尖端扭转型室性心动过速 左心交感神经切除术 麻醉 

分 类 号：R654.2[医药卫生—外科学]