摘要
目的：回顾性分析总结36例重症心脏瓣膜置换术的麻醉处理经验。方法：36例重症心脏瓣膜置换术病人，X线胸片心胸比（C／T）0．68～0．90，心功能Ⅲ～Ⅳ级，左室舒张末径（LVEDD）平均67±9．2mm，术前均经过严格改善心功能治疗，选择有利的手术时机，采用以芬太尼为主，咪唑安定、异丙酚、异氟醚等为辅助药的全身麻醉，中度低温体外循环，以高钾含血冷停跳液灌注心脏，心脏复苏后静脉输注多巴胺等维持血流动力学稳定。结果：全组病例围术期死亡4例（11．1％），其余均顺利康复出院。结论：完善的术前准备和重视术后心肺功能的支持治疗，是手术成功的重要基础；以芬太尼等为主的静吸复合麻醉、及高钾含血冷停跳液灌注心脏的方法，用于重症心脏瓣膜置换术效果良好。
Objective ： Retrospectivly analyzed and summarized experience of anesthetic treatment of 36 cases severe cardiac valve replacement. Method： 36 cases severe cardiac valve replacement whose cardio/thorax （C/T） were 0.68～0.90 measured by sternite, heart function were Ⅲ～Ⅳ grade, average of left ventricle diastole diameter （LVEDD） was 67±9.2mm. All the patients heart function were improved by strict therapy before operate. Selecting best opportunity for operation, by general anesthesia, moderate hypothermia extracorporeal circulation, perfusing heart by cold stop - beating fluid including hypokalium and blood, and refusing dopamine to maintain haemodynamics after cardiac resuscitation. Result： All the patients rehabilitation discharge except 4 cases （11.1%） died. Conclusion： Successful cardiac valve replacement based on consummate prepare for preoperative, supportive treatment postoperative, general anesthesia, moderate hypothermia extracorporeal circulation, and perfusing heart by cold stop - beating fluid including hypokalium and blood.
出处
《河北医学》
CAS
2006年第7期640-642,共3页
Hebei Medicine
关键词
麻醉
体外循环
心脏瓣膜置换术
General anesthesia
Extracorporeal circulation
Cardiac valve replacement
