右肺动脉缺如患儿行后路脊柱侧凸矫形术的麻醉管理一例  

Anesthesia management for posterior correction of scoliosis in a child with absence of the right pulmonary artery:a case report

作　　者：代子一 马璐璐[1] DAI Ziyi;MA Lulu(Department of Anesthesiology,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院麻醉科,北京100730

出　　处：《基础医学与临床》2025年第4期532-535,共4页Basic and Clinical Medicine

基　　金：2022年临床研究专项青年培优计划项目(2022-PUMCH-A-062)。

摘　　要：目的探讨单侧肺动脉缺如(UAPA)患儿行后路脊柱侧凸矫形术的围术期麻醉管理策略。方法回顾性采集一例合并右肺动脉缺如的青少年男性患者行后路脊柱侧凸矫形术的临床诊治资料,并对本例患者的术前评估、术中麻醉管理和术后疼痛治疗进行分析与总结。结果UAPA是罕见的先天性心血管畸形,可进一步增加脊柱侧凸患者手术治疗的心血管及呼吸系统风险。本例UAPA患儿合并咯血症状,经多科会诊评估后,制定咯血应急预案,术中予有创动脉压监测,充分镇痛,密切呼吸监测,采取肺保护性通气策略。术后保证呼吸功能基础上,进行多模式镇痛,治疗效果满意后出院。结论对有症状的UAPA患者,临床医生需重点关注循环及呼吸系统,维持围术期血流动力学稳定,避免缺氧及二氧化碳潴留,以降低并发症风险。Objective To discuss the perioperative anesthesia management strategy for posterior correction of scoliosis in children with unilateral absence of pulmonary artery(UAPA).Methods Clinical data of one case of an adolescent male with absence of right pulmonary artery receiving posterior scoliosis correction surgery was retrospectively collected;the preoperative evaluation,intraoperative anesthesia management and postoperative pain treatment were analyzed and summarized.Results UAPA is a rare congenital cardiovascular anomaly that can further increase the cardiovascular and respiratory risks of surgical treatment in scoliosis patients.As the patient was concurrent with hemoptysis,after multidisciplinary consultation and evaluation,an emergency plan for hemoptysis was developed,and invasive arterial pressure monitoring,sufficient analgesia,close respiratory monitoring,and lung protective ventilation strategy was performed intraoperatively.Ensuring respiratory function after surgery,multimodal analgesia was administered.Confirming satisfactory treatment results,the patient was discharged from the hospital.Conclusions For symptomatic UAPA patients,clinicians should focus on the circulation and respiratory system,maintain perioperative hemodynamic stability,prevent hypoxia and carbon dioxide retention so to reduce the risk of complications.

关 键 词：单侧肺动脉缺如 脊柱侧凸 咯血 

分 类 号：R614[医药卫生—麻醉学]