二尖瓣叶腱索断裂患者行二尖瓣成形术围手术期监测参数及并发症发生情况  

Perioperative monitoring parameters and complications of mitral valve chordae rupture undergoing mitral valve repair

作　　者：都义日[1] 于钦军 王水云 孙宏涛 陈雷 Du Yiri;Yu Qinjun;Wang Shuiyun;Sun Hongtao;Chen Lei(Department of Anesthesiology,Fuwai Hospital of Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]内蒙古医科大学附属医院麻醉科,呼和浩特010050 [2]中国医学科学院阜外医院麻醉中心,北京100037 [3]中国医学科学院阜外医院成人心脏外科中心,北京100037

出　　处：《中国循证心血管医学杂志》2018年第8期975-978,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的回顾性分析阜外医院一组因二尖瓣叶腱索断裂行二尖瓣成形术的临床资料,总结二尖瓣成形手术的麻醉经验和手术特点。方法选择北京阜外医院于2009年1月~2011年6月因二尖瓣叶腱索断裂致二尖瓣关闭不全的患者64例,其中男性45例,女性19例,年龄(41.5±10.6)岁,范围22~67岁。全部病例均在芬太尼或舒芬太尼全麻体外循环下行二尖瓣成形术,围术期均使用经食管超声心动图进行监测。体外循环期间根据需要进行改良超滤。术中持续监测血流动力学变化,记录体外循环时间、主动脉阻断时间、气管拔管时间和住院时间等指标。统计住院死亡率和手术相关并发症,并比较手术前后超声心动图左房内径(LAD)、左室舒张末期内径(LVEDD)和左室射血分数(LVEF)等参数变化。结果全组患者术中血流动力学平稳,无严重心律失常及不良事件发生。术中均未输注异体浓缩红细胞和新鲜冰冻血浆。体外循环时间(83.7±37.6)h,ICU清醒时间(8.4±3.6)h,气管拔管时间(11.9±4.3)h,ICU停留时间(28.5±13.6)h,住院时间(13.1±3.3)d。住院期间未发生死亡,术后肺部并发症(严重低氧血症)2例(3%)。结论由于二尖瓣关闭不全的病理生理和手术操作的特殊性,要取得满意的临床效果,需要有经验的团队密切协作。麻醉处理也有其特殊性,维护左心功能,适当降低前、后负荷,保持合适的心率和控制血压等是麻醉处理的关键。体外循环中使用超滤,术中使用经食管超声心动图监测和指导,同时加强心、肺、脑和血液保护,可以取得满意的临床转归。Objective To retrospectively analyze the clinical data of a group of mitral valvuloplasty due to mitral valve chordae rupture and summarize the anesthesia experience and surgical characteristics of mitral valve surgery.Method This retrospective study was conducted in 64 cases of the chordal rupture of mitral anterior or posterior leaflet resulting in regurgitation.(male 45 and female 19)aged from 22 to 67 years.They underwent the mitral valve repair with cardiopulmonary bypass by general anesthesia of high dose intravenous fentanyl or sufentanyl.All patients received intraoperative transesophageal echocardiography(TEE).They had been taken the modified ultrafiltration during cardiopulmonary bypass if needed.Intraoperative hemodynamics was monitored continually.Cardiopulmonary bypass time,aortic clamping time,extubating time and hospital stay were recorded.Mortality and main complications in hospital were calculated.The parameters of transesophageal echocardiography,such as left atrial diameter,left ventricular end-diastolic diameter and left ventricular ejection fraction,were compared before and after operation.Result All patients were stable in hemodynamics and there were no serious arrhythmia and malignant adverse events during perioperative period.Cardiopulmonary bypass time was 83.7±37.6 min while the average postoperative recovery time and extubating time were 8.4±3.6 hours and 11.9±4.3 hours respectively.Average hospital stay time was 13.1±3.3 days while the average ICU stay was 28.5±13.6 hours.The mortality in hospital was zero and only two cases(3%)suffered from postoperative pulmonary complications(severe hypoxemia).Blood product(allogeneic red blood cell or fresh frozen plasma)were not used during operation.Conclusion Pathophysiology of the patients with mitral regurgitation and mitral repair procedure were more complicated.Experienced teamwork was essential to achieve satisfactory clinical results.The key points of anesthesia management were to protecting left ventricular function,appropriate decre

关 键 词：二尖瓣成形术 麻醉 经食管超声心动图 

分 类 号：R654.2[医药卫生—外科学]