胸腔镜辅助下双侧肺静脉隔离治疗心房颤动的麻醉管理  

An esthesia management of video-assisted bilateral pulmonary vein isolation for atrial fibrillation

作　　者：王凯元[1,2] 王洪武[1] 薛玉良[1,2] 赵聚钊[1] 辛连峰[1] 

机构地区：[1]泰达国际心血管病医院麻醉科,天津300457 [2]天津医科大学研究生院,天津300457

出　　处：《国际麻醉学与复苏杂志》2011年第3期284-287,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的 总结胸腔镜辅助下肺静脉隔离及左心耳切除术（Wolf Mini-maze手术）治疗心房颤动（房颤）的麻醉管理经验。方法 回顾性分析了14例接受Wolf Mini-maze手术患者的临床资料。术中对患者实施左、右肺单肺通气，射频消融前后进行电生理检查。分别记录左肺和右肺单肺通气开始前（T1），开始后15min（T2），射频消融前即刻（T3），射频消融时（T4）患者心率（HR）、收缩压（SBP）、中心静脉压（CVP）、脉搏血氧饱和度（oxygen saturation，SpO2）、气道峰压（Pmax）、呼气末二氧化碳分压（PetcO2）。结果 所有患者平均麻醉时间（4．9±1．5）h，重症加强护理病房（ICU）带管时间（9±4）h，ICU停留时间（72±35）h。单肺通气开始后，患者SpO2降低，伴有Pmax升高，以左肺单肺通气时显著（p＜0．05）。射频消融前后，可出现SBP降低，SpO2升高（P〈0．05）。12例患者术中射频消融后即刻转为窦性心律，2例ICU治疗期间转为窦律。随访未发现明显的手术相关并发症。结论 Wolf Mini-maze手术术中患者呼吸功能和血流动力学指标常有波动，麻醉要点为积极预防和处理单肺通气期间的低氧血症，熟悉外科操作和电生理检查过程，维持术中血流动力学稳定。Objective To summarize the anesthesia management of video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion （Wolf Mini-maze procedure） for atrial fibrillation（AF）. Methods The clinical files of 14 patients who received Wolf Mini-maze procedure were retrospectively analyzed. All patients received one lung ventilation（OLV, left and right lung in succession） and intraoperative Electrophysiologic （EP） testing. The heart rate（HR）, systolic blood pressure（SBP）, central venous pressure （CVP）, oxygen saturation （SpO2）, Pmax and end-tidal partial pressure of carbon dioxide （PzrCO2） were monitored and recorded before and at 15 rain after OLV, before and during the ablation. Results The average anesthetic time was （4.9±1.5） h, the extubation time in ICU was （9±4） h and the ICU staying time was （72±35） h. After one lung ventilation, the SpO2 decreased while the Pmax increased, especially in the period of left lung ventilation （P〈0.05）. The SBP decreased and the SpO2 increased before and during the ablation（P〈0.05 ）. 12 patients were free of AF after the ablation in the operation room, and the other 2 patients retrieve sinus rhythm during the ICU. No patient develpoed serious complications in the postoperative follow-up. Conclusion The variability of respiratory function and the hemodynamics could be found during the Wolf Mini-maze procedure. The anesthesiologist should be familiar with the surgical procedure and the EP testing Intraoperative hemodynamics should be maintained stable and the hypoxemia during one lung ventilation should be prevented.

关 键 词：电视辅助 肺静脉隔离 房颤 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]