针药复合麻醉下无气管插管心脏瓣膜置换术86例术后监护  

Post-operative Management for 86Cases of Heart Valve Replacement Surgery Patients Undergoing Transcutaneous Electrical Acupoint Stimulation Combined with General Anesthesia

作　　者：周文雄[1] 徐建俊[1] 吴瑶瑶[1] 池浩[1] 陈彤宇[1] 葛文[1] 周嘉[1] 

机构地区：[1]上海中医药大学附属曙光医院心胸外科,上海201203

出　　处：《针刺研究》2014年第1期16-19,共4页Acupuncture Research

基　　金：上海市中医药事业发展三年行动计划(重大研究)项目"针药复合麻醉优选方案及临床疗效评价研究"(ZYSNXD-CC-ZDYJ 014);上海市科学技术委员会科研项目"基于心脏瓣膜手术的针药复合麻醉技术规范化"(No.12401903200)

摘　　要：目的:回顾性分析86例针药复合麻醉心脏瓣膜置换术患者的术后重症监护室(ICU)处理情况,总结针药复合麻醉心内直视手术后的监护经验。方法:自2006年7月至2012年6月,86例心脏瓣膜病患者行针药复合麻醉下的体外循环心内直视手术(经皮电刺激中府、尺泽和郄门)。术后ICU监护处理包括:严密进行血流动力学监测、常规应用多巴胺和硝酸甘油等血管活性药物、吸氧、神经系统功能和肾功能监测、适当镇痛治疗。结果:本组病人无围术期死亡,无术后因呼吸循环衰竭而气管插管、呼吸机辅助,平均ICU停留时间(28.6±6.2)h,无二次止血病例,术后平均纵隔引流量(291±73)mL。患者术后切口疼痛7例(8.14%),术后发生心功能不全5例(5.81%),肺部感染8例(9.30%),低氧8例(9.30%),术后早期胃胀气13例(15.12%),无脑梗死病例发生,3例(3.49%)出现轻度肾功能不全,发热>38.5℃者1例(1.16%)。结论:针药复合麻醉用于体外循环心脏手术,方法可行,安全有效。术后监护处理重点是容量调节、体温管理、疼痛治疗。Objective To summarize post-operative management strategy for heart valve replacement surgery under transcutaneous electrical acupoint stimulation （TEAS） combined with general anesthesia. Methods From July 2006 to June 2012, a total of 86 cases of open-heart surgery patients experiencing TEAS plus general anesthesia with cardiopulmonary bypass （heart valve replacement surgery without intubation） were recruited in the present summary. Post-operative managements in the Intensive Care Unit （IOU） were administrated with strict hemodynamic monitoring for volume infusion, routine administration of va- soactive drugs （including dopamine and nitroglycerin）, oxygen inhalation, and analgesics and monitoring of central nervous system and renal function. Results All the 86 patients under TEAS ＋ general anesthesia and cardiopulmonary bypass and without intuba- tion experienced successful heart valve replacement surgery. The post-operative pulmonary infection was found in 8 cases （9.30%）, the average stay duration in ICU was （28.6±6.2） hours, and the average draining volume of the interpleural space was （291±73） mL. The cardia insufficiency was found in 5 cases （5.81% ）, hypoxia occurred in 8 cases （9.30 % ）, nausea in 8 cases （9.30%）, vomiting 5 cases （5.81% ） and post-operative gastrointestinal distension 13 cases （ 15. 12% ）, mild renal insuffi- ciency 3 cases （3.49%）, fever （〉38.5 ℃） 1 case（1. 16%） and severe post-operative pain 7 cases （8. 14%）. Conclusion TEAS combined with general anesthesia is safe for patients undergoing heart valve replacement surgery under cardiopulmonary by- pass. The key points of treatment in ICU are volume infusion, body temperature maintenance, and pain control.

关 键 词：针药复合麻醉 心脏瓣膜置换术 无气管插管手术 术后并发症 

分 类 号：R246.2[医药卫生—针灸推拿学]