成人先天性心脏病患者神经外科围手术期管理  

Perioperative management of adult patients with congenital heart disease undergoing neurosurgery

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作  者:吴蓓[1] 杨柳[1] 韩如泉[1] WU Bei;YANG Liu;HAN Ruquan(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区:[1]首都医科大学附属北京天坛医院麻醉科,北京100070

出  处:《基础医学与临床》2023年第7期1138-1142,共5页Basic and Clinical Medicine

基  金:北京市医院管理局“登峰”人才培养计划(DFL20180502);北京市科委科技计划(Z19110700660000)。

摘  要:目的回顾性分析成人先天性心脏病(ACHD)患者行神经外科手术围手术期资料,总结围手术期管理特点。方法收集北京天坛医院2018年1月至2022年12月21例ACHD患者神经外科手术的围手术期资料,分析人口学资料、术前先心病类型及合并症、围手术期麻醉管理、术后并发症及转归。结果21例中,16例房间隔缺损,4例室间隔缺损,1例为单心房、单心室,伴紫绀和代偿性血红蛋白增多;19例左向右分流,1例双向分流;11例伴心腔增大(右心和左房)。20例接受全身麻醉,1例接受神经阻滞区域麻醉。6例患者术中需长时间泵注血管活性药物维持循环。术中液体平衡量为-6~+913 mL/h。手术时长46~355 min。6例患者术后返回ICU。平均住院时长(12.5±5.9)d。其中4例患者术后出现中枢神经系统感染、2例电解质紊乱、2例凝血功能异常、1例下肢静脉血栓、1例肝功能异常和1例死亡。结论循环管理、液体管理及心肺功能监测与维护是ACHD患者神经外科围手术期管理重点。Objective To review and analyze the perioperative anesthesia management of patients with adult congenital heart disease(ACHD)underwent neurosurgery,and to summarize the key points of perioperative anesthesia management for these patients,so as to achieve the goal of high clinical quality development.Methods This retrospective study analyzed the perioperative medical records of patients with ACHD underwent neurosurgery from January 2018 to December 2022.Demographic data,CHD types and complications,perioperative anesthesia management,postoperative complications and prognosis were analyzed.Results A total of 21 ACHD patients underwent neurosurgery were included in this analysis,16 with atrial septal defect,4 with ventricular septal defect,and 1 with single atrium and single ventricle accompanied with cyanosis and compensated hyper-hemoglobin.Left to right shunt was observed in 19 cases,and bidirectional shunt in 1 case.11 cases were associated with heart chamber enlargement(right heart and left atrium).20 cases received general anesthesia,and 1 case received nerve block regional anesthesia.six cases were persistently injected vasoactive drugs to maintain circulation stabilization.The intraoperative fluid balance was-6~+913 mL/h.The operation time was 46~355 min.6 cases returned to ICU after surgery.4 cases suffered central nervous system infection,2 electrolytes disturbances,2 coagulation abnormalities,1 lower limb venous thrombosis,1 abnormal liver function,and 1 death.The average length of hospitalization was(12.5±5.9)days.Conclusions Circulatory,cardiopulmonary function and fluid therapy are the key points of perioperative management of ACHD patients undergoing neurosurgery.

关 键 词:成人先天性心脏病 神经外科手术 围手术期 麻醉管理 转归 

分 类 号:R541.1[医药卫生—心血管疾病] R651.11[医药卫生—内科学] R614[医药卫生—临床医学]

 

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