体外膜肺氧合辅助下序贯式双肺移植的麻醉管理  

Anesthesia management of bilateral sequence lung transplantation with the assistant of extracorporeal memberane oxygenation

作　　者：胡春晓[1] 张建余[1] 张渊[1] 张正正[1] 王桂龙[1] 王雁娟[1] 胡毅平[1] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,无锡市214073

出　　处：《临床麻醉学杂志》2008年第7期595-597,共3页Journal of Clinical Anesthesiology

基　　金：国家卫生部科技发展基金重大课题资助项目(WKJ2004-2-008)

摘　　要：目的总结体外膜肺氧合（ECMO）辅助下序贯式双肺移植的麻醉处理及术中运用ECMO支持的经验。方法8例终末期肺病患者术前进行了充分的调整和准备，手术均为双侧前胸切口序贯式双肺移植。麻醉诱导常规采用咪唑安定、芬太尼、依托咪酯及维库溴铵诱导，肌肉松弛后行气管内插管；术中麻醉维持以静脉持续泵注丙泊酚和维库溴铵，间断静注芬太尼。术中严密监测各项生命体征，根据血气指标及生命体征调节机械通气参数，必要时行手控通气。所有患者于麻醉诱导后进行股动、静脉穿刺置管，并给予ECMO辅助，转流期间维持激活凝血时间（ACT）160～200s，血流量1．8～2．5L·m^-2·min^-1。结果所有患者在麻醉诱导机械通气下生命体征平稳，手术过程顺利。结论ECMO是双肺移植术中心肺辅助的有效手段，可提高肺移植手术的麻醉成功率。Objective To summarize the experience of anesthesia management and application of extracorporeal memberane oxygenation（ECMO） in bilateral sequence lung transplantation. Methods Eight patients with end stage of pulmonary disease underwent bilateral sequence lung transplantation via bilateral anterolateral thoracotomy after sufficient preoperative preparation. Anesthesia was induced with midazolam, fentanyl, etomidate and vecuronium and maintained while fentanyl injection. Vital signs were monitored during the operation, mechanical ventilation was modulated according to the blood gas analysis, and manual ventilation was performed if necessary. ECMO with a flow rate of 1.8-2.5 L· m^-2 ·min^-1 was used in all patients under ACT 160-200 s. Results All of the operations were successful with stable vital signs. Conclusion ECMO is a valuable assistant in the patients undergoing bilateral sequence lung transplantation.

关 键 词：体外膜肺氧合 肺移植 临床分析 治疗方法 

分 类 号：R614[医药卫生—麻醉学]