80例序贯式双肺移植的麻醉管理  

Anesthetic management of 80 cases of bilateral sequential lung transplantation

作　　者：秦钟[1] 杨勇刚[1] 王志萍[1] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,江苏无锡214023

出　　处：《临床肺科杂志》2015年第11期2024-2026,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨80例序贯式双肺移植的麻醉管理和注意事项。方法选择接受序贯式双肺移植患者80例,全麻诱导后插入左双腔支气管导管,通气方式采用压力控制模式,麻醉维持采用泵注丙泊酚和顺苯磺酸阿曲库铵,间断静注舒芬太尼镇痛。诱导完成后经右颈内静脉置入Swan-Gans导管,左股动脉置入脉搏指示连续心排量(PICCO)导管监测心排量和外周血管阻力等指标。结果 80例序贯式双肺移植的手术时间平均为453.1±83.5 min,术中出血量为2021.3±1235.7 ml。37例双肺移植在体外膜肺(ECMO)辅助氧合下完成,有8例患者术后需ECMO辅助氧合,其余患者均在双肺移植完成后撤除ECMO。在非ECMO辅助氧合的移植患者中,有23例在行首侧肺移植过程中发生氧饱和下降,经阻断肺动脉后好转。所有移植病例在肺移植完成后肺动脉压力明显下降。结论序贯式双肺移植的麻醉管理在于术前对患者病情的正确评估,术中应对循环、呼吸以及内环境进行全方位的监测与精细化处理。Objective To explore the anesthetic management of 80 cases of bilateral sequential lung trans-plantation. Methods The study selected 80 patients received sequential bilateral lung transplantation. Left-sided double-lumen tube was inserted and mechanical ventilation was given in PCV mode after induction of general anesthe-sia. Anesthesia was maintained by pumping propofol, cisatracurium besilate and sufentanil. Swan-Gans catheter was inserted in the right internal jugular vein and PICCO catheter was inserted in the left femoral artery to monitor cardiac output and peripheral vascular resistance index. Results The mean operative time of 80 sequential bilateral lung transplantation was 453. 1 ± 83. 5min, and blood loss was 2021. 3 ± 1235. 7ml. 37 cases were under extracorporeal membrane oxygenation （ ECMO） assist for surgery, and 8 of them needed ECMO assist after surgery. In the cases with-out ECMO assist, 23 occurred oxygen saturation decreased during the first side lung transplant, and it was improved when pulmonary artery was blocked. Pulmonary artery pressure decreased significantly after surgery. Conclusion Suc-cessful anesthesia management for bilateral sequential lung transplantation is related with correct preoperative assess-ment, the universal monitor and treatment of circulatory, respiratory, and internal environment during surgery.

关 键 词：肺移植 麻醉 

分 类 号：R614[医药卫生—麻醉学]