达芬奇机器人辅助不停跳冠状动脉旁路移植术的麻醉管理  

Management of Anesthesia during Da Vinci Robot Assisted Off-pump Coronary Artery Bypass Grafting

作　　者：宋丹丹[1] 刁玉刚[1] 孙莹杰[1] 汪海涛[1] 张毅男[1] 张铁铮[1] 

机构地区：[1]沈阳军区总医院麻醉科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2016年第2期124-127,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：辽宁省自然科学基金项目(2014020063)~~

摘　　要：目的总结达芬奇（Da Vinci）机器人辅助不停跳小切口冠状动脉旁路移植术麻醉管理要点。方法回顾性分析2011年5月至2014年12月我院达芬奇机器人辅助不停跳左前外侧小切口冠状动脉旁路移植手术24例（男20例，女4例），平均年龄（62．1±12．8）岁。所有患者入室后连续监测有创血压，全身麻醉诱导后插入双腔支气管导管、纤维支气管镜定位，术中右侧单肺通气，放置Swan—Ganz漂浮导管，监测经食管超声心动图、行血气分析并分析血流动力学变化。结果所有患者麻醉诱导期状态平稳，未发生严重低氧血症和高碳酸血症。手术过程顺利，无中转开胸手术。术后当日均顺利脱离呼吸机，机械通气时间（5．3±2．8）h，并均于术后18h内出ICU，无术后开胸止血，全组患者无手术死亡和围术期并发症，术后4～5d顺利出院。术后1个月、3个月、6个月门诊随访无再发心血管事件。结论该麻醉方法恢复快、并发症少，减轻了患者的痛苦，是一项安全有效的新技术，麻醉管理安全可靠，患者满意度较高。Objective To summarize the management of anesthesia during robotic off-pump coronary artery bypass grafting （CABG） with the da Vinci Surgical System in minimal thoractomy. Methods From May 2011 to December 2014, 24 patients （20 males and 4 females） at the average age of 62.1± 12.8 years underwent robotic off-pump CABG with the da Vinci Surgical System in our hospital. All the patients underwent the continuous invasive blood pressure monitoring, endotracheal intubation with the double-lumen tube after induction of general anesthesia, fiber bronchoscope positioning, intraoperative application of one-lung ventilation, placing the Swan-Ganz floating catheter, and monitoring the echocar- diography （TEE） and blood gas analysis and indexes of hemodynamics. Results All the patients were stable during the anesthesia induction period. There was no severe hypoxemia and hypercapnia. The surgery was successful and there was no thoracotomy. All the patients left off breathing machine postoperatively.The duration of mechanical ventilation was 5.3±2.8 hours. All patients were moved out from ICU in 18 hours.There was no thoracotomy for hemostasis after surgery. All the patients were discharged on the fourth or fifth day postoperatively. There was no death relevant to surgery or perioperative complications. There was no recurrence of cardiovascular events on the 30th day,3 months and 6 months postoperative follow-up. Conclusion This anesthesia method is safe and effective. It is a rapid recovery way with the fewer complications, less suffering of the patients, reliable anesthesia management and high satisfaction of the patients＇.

关 键 词：全身麻醉 冠状动脉旁路移植术 达芬奇机器人外科系统 

分 类 号：R614[医药卫生—麻醉学]