Ebstein畸形矫治术的麻醉管理  

Anesthetic management in patients with Ebstein＇s anomaly undergoing corrective operation

作　　者：张日英 邓劲松 韦华 李波 李家胜 

机构地区：[1]商州市人民医院麻醉科,广东省525200

出　　处：《中国心血管病研究》2009年第4期274-276,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨三尖瓣下移畸形（Ebstein畸形）矫治术的麻醉管理。方法回顾总结我院20例Ebstein畸形患者，年龄2～38岁，体重11-42kg；美国麻醉医师学会（ASA）分级Ⅲ级。采用气管插管静吸复合全身麻醉及浅低温体外循环下行Ebstein畸形矫治术。术中监测有创动脉血压、中心静脉压、脉搏氧饱和度、呼气末二氧化碳分压、尿量、心电图，间断查血气。开放升主动脉前泵入多巴酚丁胺3～8μg·kg^-1·min^-1。结果开放升主动脉后心脏均自动复跳，1例心动过缓，2例发生Ⅱ°房室传导阻滞，经过药物处理后好转；2例发生Ⅲ°房窄传导阻滞，药物治疗效果不佳，安装临时心外膜起搏导线；其余患者复跳顺利，均顺利停体外循环辅助。本组患者术后第1天均拔除气管导管，全组顺利出院。结论Ebstein畸形矫治术麻醉管理的重点为术中需维持一定的麻醉深度，体外循环后重点降低右室前、后负荷，避免增加肺血管阻力，对复跳后的心律失常应积极处理，防止恶性心律失常的发生。多巴酚丁胺用于Ebstein畸形矫治术在增强心肌收缩力的同时可降低右事后负荷。Objective To explore anesthetic management in patients with Ebstein＇s anomaly undergoing corrective operation. Methods 20 ASAm patients aged 2 to 38 years, weighed 13 to 42 kg underwent corrective operation of Ebstein＇s anomaly. Invasive blood pressure （IBP）, central venous pressure（CVP）, saturation of pulse oxygen （SPO2）, partial pressure of carbon dioxide in endexpiratory gas （PETCO2）, urinary volume, electrocardiogram （ECG） were monitored continually and arterial blood gas analysis was done intermittently. 3-8μg·kg^-1·min^-1 dobutamine was injected i.v by pump after rewarm. Results All cases achieved spontaneous resuscitation after aotic declamping. One case occurring bradycardia and two cases occuring Ⅱ° atrial ventricular block（AV-B） became normal after isoprenaline i.v. Two cases occurring Ⅲ°AV-B were attached temporary pacing epicardial .All cases separated from extracorporeal circulation successfully and extracted endotracheal catheter in 1 or 2 postoperative day and discharged smoothly. Conclusion The emphasis of anesthetic management are keeping adequate anesthetic depth, reducing preload and aflerload of right ventricle and pulmonary vascular resistance, dealing arrhythmia, especially malignant arrhythmia actively. Dobutamine can not only improve myocardial contractility but also reduce afterload of right ventricle.

关 键 词：三尖瓣下移畸形 麻醉 

分 类 号：R614.21[医药卫生—麻醉学]