摘要
目的探讨胸腔镜体外循环(CPB)下心脏手术的麻醉管理方法。方法选择30例心脏病患者,术前心功能纽约心脏病协会(NYHA)分级为Ⅰ～Ⅲ级,采用双腔或单腔气管插管静吸复合全麻,手术的主要步骤通过单肺通气来暴露术野,分次给予舒芬太尼镇痛,顺苯磺酸阿曲库铵维持肌肉松弛,微泵静脉注入丙泊酚镇静,并根据需要间断吸入七氟烷维持麻醉。结果手术时间120～300min,平均(208.1±87.5)min,转机时间60～211min,平均(134.7±64.2)min,阻断时间30～120min,平均(74.9±43.5)min,复温后29例自动复跳,28例患者当日拔除气管导管,全部患者住院5～8d,平均(7.1±0.7)d,均顺利出院。结论胸腔镜下心脏手术,创伤小、恢复快;合理选择麻醉药物、加强呼吸管理和肺保护将有助于患者术后早期拔管;完善的单肺通气管理和循环管理是此类手术麻醉管理的关键。
Objective To summarize anaesthesia management of thoracoscopic cardiac surgery with cardiopulmonary bypass （CPB）. Methods 30 patients with heart diseases were operated by thoracoscopic approach. Anaesthesia were performed through double-cavity tube or single-cavity tube in the trachea. Exposured the operation area by one-lung ventilation,gived sufentanil times to ease pain,gived atracurium to maintain muscle relaxation,gived propofol through tiny-pump to Sedation,inhaling disconnectedly isoflurane to maintain anaesthesia. Results The duration of surgery ranged from t20 to 300 minutes, and the average level was （208. 1-I-87. 5） minutes. The duration of cardiopulmonary bypass ranged from 60 to 211 minutes, and the average level was （134.7 ~ 64.2） minutes. The blocking duration of the ascending aorta ranged from 30 to 120 minutes, and the average level was （74. 9 ~ 43.5） minutes. With 29 cases of auto-resuscitation after rewarming and 28 patients extubation on the same day, All the patients were discharged,hospitalized 5-8 days,and the averge level was（7.1±0.7） days. Conclusion Due to less trauma and quicker re-covery of thoracoseopic cardiac surgery, reasonable election of anesthetic drugs and intensive breathing management and lung prote-tion could be helpful to early tracheal extubation and recover of patients. General intravenous anesthesia, close monitoring, and com-plete one-lung ventilation and circulation management are key steps for the success of thoracoscopic cardiac surgery.
出处
《重庆医学》
CAS
CSCD
北大核心
2013年第16期1812-1813,1816,共3页
Chongqing medicine
基金
重庆市卫生局2012年医学科研计划基金资助项目(2012-2-188)
关键词
胸腔镜
体外循环
心脏手术
麻醉
thoracoscope
extracorporeal circulation
cardiac surgery
anesthesia
