肥厚型梗阻性心肌病患者行左心室流出道疏通术的麻醉管理  

The anesthetic management of left ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy

作　　者：迟慧[1] 卿恩明[1] 来永强[1] 贾清彦[1] 

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

出　　处：《心肺血管病杂志》2013年第3期337-339,共3页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市卫生系统高层次人才项目-学科带头人(SF-2011-02-17)

摘　　要：目的:总结肥厚型梗阻性心肌病(HOCM)患者行左心室流出道疏通术的麻醉管理经验。方法:70例HOCM患者在全身麻醉体外循环下行左心室流出道疏通术,麻醉诱导和麻醉维持采用咪达唑仑、丙泊酚、异氟烷、芬太尼和哌库溴铵,术中持续监测ECG、HR、脉搏血氧饱和度(SPO2)、有创动脉血压(IBP)、中心静脉压(CVP)、心输出量(CO)、心脏排血指数(CI)、外周血管阻力(SVR)、肺血管阻力(PVR)及平均肺动脉压(MPAP)。术中部分患者使用艾司洛尔、去氧肾上腺素及地尔硫卓等维持血液动力学平稳。结果:术中血液动力学平稳,无严重心律失常发生,全组均顺利完成手术。结论:麻醉管理的关键在于①以适度的麻醉深度避免抑制心肌收缩力;②维持正常的心率和血压,酌情使用增强心肌收缩力的药物;③维持好前后负荷,避免使用血管扩张药;Objective：To review the anesthetic management of left ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy（HOCM）.Methods： 70 consecutive patients with HOCM underwent left ventricular outflow septal myectomy under general anesthesia and cardiopulmonary bypass.Midazolam,propofol,fentanyl,isoflurance and pipecuronium were used to induce and maintain anesthesia.ECG,HR,SPO2,IBP,CVP,MAP,CO,CI,SVR,PVR,MPAP were monitored continuously.The medicinal usage of the Esmolol,Phenylephrine,Diltiazem made the hemodynamics stable in operation.Results： The hemodynamics was stable and there no serious ventricular arrhythmias occurred in operation.Conclusion： Anesthetic management should focus on the following strategies in patients with left ventricular septal myectomy： ①reduction of myocardial contractility by adequate deep anesthesia;②keeping sufficient preload and afterload,and avoiding the use of vasodilators;③maintaining adequate heart rate and blood pressure,and avoiding the use of positive inotropics.

关 键 词：肥厚型梗阻性心肌病 左心室流出道疏通术 麻醉管理 

分 类 号：R54[医药卫生—心血管疾病]