肺动脉血栓内膜剥脱术的麻醉管理  

Anesthesia management for pulmonary thromboendarterectomy

作　　者：彭科军[1,2,3] 卿恩明[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所麻醉科,北京100029 [3]首都医科大学附属北京右安医院麻醉科

出　　处：《心肺血管病杂志》2011年第6期535-538,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨肺动脉血栓内膜剥脱术(pulmonary thromboendarterectomy,PTE)的麻醉方法。方法:通过对19例行肺动脉血栓内膜剥脱术的患者术前状况,手术方式、麻醉管理、术后状况及预后进行分析;探索可行的麻醉经验。结果:治愈12例(63.2%);好转3例(15.8%);术后早期死亡2例(10.5%),其中肺水肿合并肺出血1例,持续性肺动脉高压1例;放弃治疗2例(10.5%),均为持续性肺动脉高压;术后体外循环膜肺支持(extracorporeal membrane oxygenation,ECMO)4例,其中死亡2例、放弃1例及治愈1例。结论:PTE患者麻醉的关键在于防治持续性肺动脉高压和血栓剥离后,肺再灌注引起的肺水肿及并发的肺出血,并注意深低温停循环对人体正常生理功能的影响。Objective：To probe anesthesia for pulmonary thromboendarterectomy（PTE）.Methods：19 cases of PTE were review of preoperative status,surgical procedure,anesthetic management,postoperative status and prognosis;to explore appropriate anesthetic method.Results：After operation,12 patients（63.2%） were cured and improvement in 3 cases（15.8%）,2 deaths（10.5%） during early postoperative period,1 patient was die of pulmonary edema with pulmonary hemorrhage,the other patient death of severe persistent pulmonary hypertension.2 cases（10.5%） were abandoned of treatment by family members,because of severe persistent pulmonary hypertension.Extracorporeal membrane oxygenation（ECMO） was used in 4 cases,of which 2 patients died,abandoning treatment 1 case,cured in 1 case.Conclusion：The key to anesthesia for PTE is to prevent severe persistent pulmonary hypertension,pulmonary edema and pulmonary hemorrhage after reperfusion;at the same time paying attention to affection of deep hypothermic and circulatory arrest.

关 键 词：肺动脉栓塞 肺动脉血栓内膜剥脱术 麻醉 

分 类 号：R563.5[医药卫生—呼吸系统]