StanfordA型主动脉夹层手术的麻醉管理  

Anesthetic management of Stanford type A aortic dissection operation

作　　者：徐建红[1] 张雄信[1] 陈寒鉴[1] 单伟峰[1] 骆丽慧[1] 祝胜美[1] 陈庆廉[1] 

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州310003

出　　处：《中华医学杂志》2012年第41期2905-2908,共4页National Medical Journal of China

摘　　要：目的探讨中低温或深低温停循环（DHCA）下手术治疗StanfordA型主动脉夹层患者围手术期麻醉管理经验。方法回顾性分析2008年6月至2011年12月浙江大学附属第一医院心胸外科行StanfordA型主动脉夹层手术治疗77例患者麻醉及围手术期监测治疗情况。结果51例患者在中低温体外循环下手术，26例在DHCA下进行。手术时间152—600（292±91）rain，体外循环时间38～310（128±43）min，心肌血运阻断时间31—169（87±26）min，26例DHCA患者停循环时间20—113（41±19）min。大部分患者通过SVV（每搏量变异度）进行容量管理，注重血液保护及脑保护。术中死亡5例，术后死亡7例。出院65例患者定期门诊随访，无死亡和需要再次手术病例。结论术中对容量的监测管理及血液保护措施是手术成败的重要因素。神经系统并发症是棘手且重要的问题。Objective To explore the anesthetic management experiences of patients with Stanford A aortic dissection undergoing surgical treatment through moderate or deep hypothermia circulatory arrest （DHCA）. Methods From June 2008 to December 2011, a total of 77 patients undergoing surgical treatment of Stanford A aortic dissection was recruited. Results Cardiopulmonary bypass （ CPB ） was established under general anesthesia in all patients. The procedures included moderate hypothermia （n = 51 ） and DHCA （ n = 26）. The total surgical duration was 152 - 600 （292 _＋ 91 ） min, CPB time 38 - 310 （ 128 _＋ 43） min and aortic cross-clamp time 31 - 169 （87 ~ 26 ）min. The time of circulatory arrest under deep hypothermia was 20 - 113 （41 _＋ 19）min in 26 patients. Among 77 patients, there were 5 intraoperative and 7 postoperative fatalities. The remained 65 patients were discharged postoperatively and received a regular outpatient follow-up. None of them died or required reoperation. Conclusion Surgical treatment is appropriate and efficient for the patients with Stanford A aortic dissection. During surgery, the keys of preventing neurological complications are blood volume monitoring and blood protection.

关 键 词：动脉瘤 夹层 麻醉 脑损伤 血管容量 循环骤停 深低温诱发 

分 类 号：R614[医药卫生—麻醉学]