经胸小切口先天性房(室)间隔缺损封堵术特点及麻醉管理  

Anesthesia management in the transcatheter closure operation of the atrium/ventricleseptal defect

作　　者：田鹏声[1] 于钦军[2] 潘湘斌[2] 欧阳文斌[2] 王龙梓 晏馥霞[1] 李立环[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院麻醉科,北京100037 [2]中国医学科学院北京协和医学院阜外心血管病医院心外科,北京100037 [3]山东省淄博市职业学院药学系

出　　处：《临床心血管病杂志》2015年第1期66-68,共3页Journal of Clinical Cardiology

基　　金：科技部国际合作项目(No:2010DFA32620)

摘　　要：目的：探讨经胸小切口在食道超声引导下进行先天性房（室）间隔缺损封堵术的麻醉管理。方法：入选经胸骨或胸骨旁小切口,在食道超声引导下进行房（室）缺封堵术的患者115例。所有病例均在静吸复合全麻下实施,麻醉以1%-3%七氟烷持续吸入为主,同时辅以右美托咪定1-2μg·kg-1·h-1持续静脉输注。手术采用经胸骨或胸骨旁小切口,直视下经右房或右室导丝置入,在经食道超声引导下进行介入封堵。由麻醉信息系统自动采集患者相关信息。结果：有5（4.3%）例封堵未成功,改为全麻体外循环下直视修补。110例经胸小切口封堵成功（95.7%）,术中失血量（18.8±14.2）ml,封堵手术时间为（63.1±27.1）min,手术操作时的心率波动差值（麻醉诱导气管插管后切皮前与手术封堵时差值的绝对值）为（24.9±19.8）次/min,手术操作时的血压波动差值（麻醉诱导气管插管后切皮前与手术封堵时平均压差值的绝对值）为（20.7±15.7）mmHg（1 mmHg=0.133kPa）。3例（2.7%）术中导丝刺激引起室上性心动过速;4例（3.6%）出现严重心动过缓（心率〈60次/min）;1例出现快速心房颤动;心律失常发生率为6.4%。术中无其他严重不良事件发生。术后拔管时间（1.9±0.6）h。住院时间（3.2±0.5）d10均顺利出院。结论：在以七氟烷吸入为主,辅以右美托咪定持续输注全身麻醉,经胸小切口、在食道超声引导下,进行房（室）间隔缺损封堵术,血流动力学稳定,手术安全,成功率高。避免了X射线损伤等并发症,失血量少。Objective：To explore the anesthesia management in the transcatheter closure operation of the atrium/ventricleseptal defect under TEE guidance by small chest incision.Method：The 115 selected cases in which patients were undergoing the closure and isolation operation of the atrium/ventricle defect through small chest incision,guided by TEE.All patients were undergone intravenous inhalation combined anesthesia,mainly with 1%-3% sevoflurane inhalation and complemented with continuous intravenous infusion of 1-2μg·kg-1·h-1 dexmedetomidine.In the operation,transcatheter closure of the right atrium/ventricle would be completed over the guide wireviastemum or small chest incision,guided by TEE.Patient information would be automatically collected by anesthesia information system.Result：The 5（4.3%）of patients＇ closure was not successful,replaced by direct repair under general anesthesia and cardiopulmonary bypass;10patients＇ closure with small chest incision were successful sealing success（95.7%）block,during which,patients intraoperatie blood loss was（18.8±14.2）ml,plugging operation time was（63.1±27.1）min,the heart rate fluctuations were in（24.9±19.8）bpm,and blood pressure fluctuations were（20.7±15.7）mmHg;3patients（2.7%）experienced supraventricular tachycardia stimulated by guide wire;4cases patients（3.6%）experienced severe bradycardia（heart rate〈60 bpm）;1patient experienced rapid atrial fibrillation;The incidence of arrhythmia was 6.4%.There was in no other serious adverse events during the operations.Postoperative extubation time was（1.9±0.6）h.The time of hospital stay was（3.2±0.5）days.All patients were successfully discharged from hospital.Conclusion：In terms of general anesthesia with mainly sevoflurane inhalation,and complemented with continuous intravenous infusion of dexmedetomidine,via small chest incision guided by TEE,the closure operation of the atrium/ventricle septal defect has high success rate with given priority to,complementary with the rig

关 键 词：房(室)间隔缺损 经胸小切口 麻醉 七氟烷 右美托嘧啶 

分 类 号：R541.3[医药卫生—心血管疾病]