主动脉弓部夹层腔内修复联合开窗手术的麻醉管理  

作　　者：李明峡 祝胜美[1] 姚永兴[1] 

机构地区：[1]浙江大学医学院附属第一医院,310003

出　　处：《浙江临床医学》2020年第8期1209-1211,共3页Zhejiang Clinical Medical Journal

摘　　要：目的 探讨主动脉弓部夹层腔内修复联合开窗手术的麻醉管理.方法 回顾性分析浙江大学医学院附属第一医院2016年7月至2018年11月共23例主动脉弓部夹层血管腔内修复(EVR)联合开窗术的麻醉及围手术期处理情况.记录并统计麻醉方法 、麻醉药物、监测手段、手术时间、术后机械通气时间、ICU停留时间、住院时间、术中及术后并发症等相关资料.结果 本组23例,均在气管插管全身麻醉下手术.以静脉快诱导、全凭静脉麻醉维持为主.辅以血管活性药物控制循环状态.监测桡动脉和中心静脉压.23例中主动脉弓部夹层腔内隔绝联合三开窗21例,主动脉弓部夹层腔内隔绝联合三开窗和锁骨下动脉补片1例,主动脉弓部夹层腔内隔绝联合两开窗1例.康复出院21例,围术期死亡2例,病死率为8.7%.结论 主动脉弓部夹层腔内修复联合开窗手术方式复杂、风险较大,对麻醉管理要求较高,维持血流动力学的稳定与良好的血压调控对预后至关重要.Objective To report the anesthesia management experience of endovascular repair combined with fenestration for aortic arch dissection.Methods From July 2016 to November 2018,23 patients of aortic arch dissection in the First Affiliated Hospital of Zhejiang University School of Medicine received endovascular repair were combined with fenestration.The anesthesia methods,anesthetic drugs,monitoring methods,operation time,mechanical ventilation time,length of stay in ICU,length of hospital stay,intraoperative and post-operative complications were recorded and statistically analyzed.Results There were 23 cases in this group.All patients were underwent general anesthesia with endotracheal intubation under rapid intravenous induction and intravenous maintenance.Invasive arterial pressure and central venous pressure were monitored.Blood pressure was controlled by vasoactive dmgs.Among these patients,21 cases underwent in situ fenestration of brachiocephalic artery,left common carotid artery and left subclavian artery simultaneously.One case underwent in situ fenestration of brachiocephalic artery,left common carotid artery,and left subclavian artery simultaneously with patch implantation on left subclavian.One case underwent in situ fenestration of brachiocephalic artery,and left common carotid artery.21 cases were discharged from hospital after rehabilitation,2 cases died during perioperative period and the fatality rate was 8.7%.Conclusion Due to the surgical complexity,the risk of endovascular repair combined with fenestration for aortic arch dissection is still high,and requires special attention in anesthesia management.lt is critical to maintain hemodynamic stability and achieve a satisfied blood pressure during the operation.

关 键 词：主动脉弓 夹层 腔内修复 开窗 麻醉 

分 类 号：R54[医药卫生—心血管疾病]