左束支传导阻滞患者行胸外科手术的麻醉处理  

Anesthetic management in thoracic surgery for patients with left bundle-branch block

作　　者：吴东进[1] 徐美英[1] 

机构地区：[1]上海交通大学附属胸科医院麻醉科,上海200030

出　　处：《徐州医学院学报》2010年第5期287-289,共3页Acta Academiae Medicinae Xuzhou

基　　金：上海市科学技术委员会科研计划项目(054119559)

摘　　要：目的探讨左束支传导阻滞(LBBB)患者行胸外科手术的麻醉处理方法。方法回顾性分析64例LBBB患者行胸外科手术的麻醉处理。依据LBBB程度及有无合并右束支传导阻滞(RBBB)将患者分为3组:完全性LBBB组(CLBBB组)11例,左前分支传导阻滞组(ALBBB组)39例,ALBBB+RBBB组14例。所有患者均在有创动脉压监测下予麻醉诱导行双腔气管导管插管,并建立中心静脉压监测,以丙泊酚、芬太尼等维持麻醉。观察各组手术与麻醉的相关情况、手术与麻醉最终结果及并发症、围术期心血管事件,并与同期本院胸外科手术整体情况进行对比研究。结果64例患者无住院死亡,3组间手术与麻醉并发症、术中循环状况差异无显著性。手术并发症率与死亡率不高于同期所有胸外科手术。结论在完善有创监测、选择合适麻醉方法、维持围术期循环平稳的基础上,CLBBB和ALBBB合并RBBB的患者可安全进行胸外科手术。Objective To explore the anesthetic management in thoracic surgery for patients with left bundle-branch block（LBBB）.Methods 64 patients with LBBB undergoing thoracic surgery were analyzed retrospectively with respect to the management of anesthesia.Based on their degrees of LBBB as well as presence or absence of accompanied right bundle-branch block（RBBB）,these patients were divided into 3 groups： complete left bundle-branch block（CLBBB） group（n=11）,anterior left bundle-branch block（ALBBB） group（n=39） and ALBBB＋RBBB group（n=14）.All the patients were anesthetized with double lumen tube,artery and central vein catheterized for continuous invasive blood pressure and central venous pressure monitoring.The perioperative cardiac events,surgical and anesthesia results and complications as well as mortality were recorded and compared with all the other thoracic cases in our hospital within the same period.Results There was no mortality in all of these patients and there was no significant difference of major complications in three groups.Conclusions With continuous invasive hemodynamic monitoring,proper anesthesia techniques and stabilized intraoperative hemodynamics,patients with CLBBB or ALBBB accompanied with RBBB can undergo secured thoracic surgery.

关 键 词：胸外科手术 麻醉 左束支传导阻滞 

分 类 号：R614[医药卫生—麻醉学]