微创心脏外科手术的麻醉管理  

Anesthetic management of minimally invasive cardiac surgery

作　　者：龚婵娟[1] 陈宇[1] 陈晓东[1] Gong Chanjuan, et al.(Anesthesiology Department, Jiangsu Province Hospital, Nanjing 210029, Chin)

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏210029

出　　处：《齐齐哈尔医学院学报》2017年第24期2898-2900,共3页Journal of Qiqihar Medical University

摘　　要：目的分析并总结微创心脏手术患者术中麻醉管理及管理效果。方法回顾性分析2009年9月至2017年9月期间,于本院完成的208例微创心脏外科手术。手术类型包括房缺(94例),二尖瓣置换(72例),左房粘液瘤(28例),三尖瓣成形(11例)和室缺(3例)。手术方式包括机器人辅助(21例),全胸腔镜辅助(153例)及小切口直视(34例)。气管插管成功后,使用支气管封堵器封堵右侧支气管实现单肺通气。术中持续监测ECG、脉搏氧饱和度(Sp O2)、有创动脉血压(IBP)、中心静脉压(CVP),常规放置经食道超声(Transesophageal echocardiography,TEE)探头及颈内静脉引流管,贴体表除颤电极。围术期使用多巴胺、多巴酚丁胺、硝酸甘油等维持循环稳定。结果 2例腔镜二尖瓣置换患者复跳后反复室颤,在TEE指导下分别予以冠状动脉搭桥、解除冠状动脉梗阻后好转;17例患者(9例腔镜二尖瓣置换、8例房缺)停机后发生了低氧血症,但在处理后得到改善,全组患者均顺利完成手术。术后机械通气时间(13.1±5.3)h,ICU停留时间(1.8±0.7)d,术后住院(7.9±1.7)d。结论微创心脏手术围术期应注意改善单肺通气过程中、停止体外转流(cardiopulmonary bypass,CPB)后的氧合。此外,TEE可引导外科医生股静脉插管的定位,并显示心脏活动、术后心脏排气情况、评估手术效果、指导麻醉治疗,建议常规使用。Objective To investigate and summarize the anesthetic requirements for minimally invasive cardiac surgery under cardiopulmonary bypass. Methods This study enrolled 208 patients undergoing minimally invasive cardiac surgery treated in Jiangsu Province Hospital from Sept,2009 to Sept,2017. Surgeries were produced by da Vinci Surgical System（ 21 cases）,under video-assisted thoracoscopic（ 153 cases） or small incision（ 34 cases）,including 94 atrial septal defect（ ASD） repairs,72 mitral valve replacement,28 left atrial myxomatectomy,11 De vega tricuspid valve repair and 3 ventricular septal defect（ VSD） repairs. All the patients received intravenous anesthesia,and right bronchial blocked by the bronchial Blocking Catheter after normal tracheal intubation. Combined anesthesia was conducted with propofol,fentanyl,atracurium and sevoflurane.Meanwhile,dopamine,dobutamine,and nitroglycerin were continuous pumped intravenously if necessary to maintain hemodynamics stability. ECG, HR, SPO2, were monitored continuously, and transesophageal echocardiography（ TEE） were also regularly monitored. Results 2 cases of mitral valve replacement occurred repeating ventricular fibrillation after heart re-beating which disappeared after the coronary artery＇s obstruction was relieved by surgeons under the guidance of TEE. 9 mitral valve replacement patients and 8 ASD repair patients were found hypoxia during one lung ventilation after weaning off the CPB,and the symptoms were alleviated after specific treatment. All surgeries were completed successfully. The postoperative mechanical ventilation time was13.1±5.3 hours,the duration of ICU care was 1.8±0.7 days,and the hospitalization time was 7.9±1.7 days after operation. Conclusions R easonable measures should be taken to manage one lung ventilation and to prevent hypoxia after weaning off the CPB during the minimally invasive cardiac surgery. TEE was suggested to be monitored regularly,for it can guide the femoral vein intubation,display the cardiac activity,ev

关 键 词：微创心脏外科手术 麻醉管理 经食道超声 单肺通气 支气管封堵器 

分 类 号：R654.2[医药卫生—外科学]