缩窄性心包炎手术麻醉分析  

ANESTHESIA EXPERIENCE OF OPERATION FOR CONSTRICTIVE PERICARDITIS

作　　者：左永文[1] 王晓斌[1] 姚怡[1] 

机构地区：[1]泸州医学院附属医院麻醉科,四川省泸州市646000

出　　处：《中国心血管病研究》2004年第1期16-18,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 回顾总结分析缩窄性心包炎患者手术的麻醉体会。方法 96例患者分为3组。A组:采用异丙酚/硫喷妥钠、司可林诱导麻醉;B组:采用氯胺酮、芬太尼、司可林诱导麻醉;C组:采用依托咪酯、芬太尼、维库溴胺/潘库溴胺诱导麻醉。3组维持麻醉方法相同。常规监测心电图、血压及尿量,C组还监测中心静脉压(CVP)及桡动脉压。观察麻醉前、后循环变化及术后低心排与死亡的发生率。结果 A组术中血压较术前明显下降(P<0.05),而B、C组术中血压维持平稳;A组和B组术后低心排发生率及病死率均明显高于C组(P<0.05,P<0.01),A组病死率又明显高于B组(P<0.05)。结论缩窄性心包炎手术麻醉宜采用依托咪酯、氯胺酮等对心肌功能抑制作用弱的药物,而需慎用异丙酚、硫喷妥钠;上腔静脉及桡动脉插管监测CVP及动脉内压作为麻醉管理的重要手段,不仅能减少术后低心排的发生,同时也能提供快速输血通道以利于术中大出血患者的抢救。Objective To summarize the anaesthesia experience of operation for constrictive pericarditis. Methods 96 patients were divided into three groups by anesthetic induction, group A: performed anaesthesia by propofol thiopental, scoline; group B: by ketamine, fentanyl, scoline; group C: by e-tomine fentanyl vecuronium/pancuronium bromide. All auepted the same anesthetic maintaining methods. ECG, blood pressure and urine volume were checked as a routine, group C were monitored the CVP and radial artery pressure. The changes of circulation pre- and post- anesthesia and the postoperative incidence of low cardiac output syndrome(LCOS) and fatality were observed. Results During operation, blood pressure significantly decreased in group A(P<0. 05), kept stead in group B and group C. The incidence of LCOS and fatality of group A and group B were all significantly higher than that of group C(P< 0. 05, 0.01 respectively) . To compared with group B, the fatality of group A was significantly higher(P<0. 05) . Conclusion Etomine and ketamine are recommended whereas propo-fol and thiopental are not suitable for operative anesthesia of patients with constrictive pericarditis. Placing cannulae in SVC and radial artery is important in anesthetic management, which can not only decrease the postoperative occurrence of LCOS, but also offer a fast - wag for blood transfusion.

关 键 词：缩窄性心包炎 手术 麻醉 心脏外科 心肌功能 

分 类 号：R654.2[医药卫生—外科学] R614[医药卫生—临床医学]