摘要
目的总结胸腔镜再次心脏房室瓣手术的麻醉处理经验。方法回顾性分析2012年1月至2014年12月在我院行胸腔镜再次心脏房室瓣手术患者的麻醉及围术期资料。所有患者采用静吸复合双腔支气管插管全身麻醉,经皮上腔静脉插管联合股动静脉插管建立外周体外循环,不阻断升主动脉,在胸腔镜下完成手术。结果本组患者25例,其中2例为第3次心脏手术。再次二尖瓣置换术11例、同期三尖瓣成形术2例及左房血栓清除术1例;再次三尖瓣置换术10例;再次三尖瓣成形术4例。手术时间(3.3±1.6)h,体外循环时间(96.5±26.9)min,最低体温(32.4±1.5)℃。20例患者心脏跳动下完成手术,5例患者室颤下完成手术,心脏切口缝合完毕后仍室颤者体外电除颤复跳。术后机械通气时间(55.9±114.0)h,重症监护室滞留时间(105.3±158.6)h,住院时间(9.5±6.3)d。全组患者发生围术期并发症6例(24.0%),术后院内死亡3例(12.0%)。结论胸腔镜下再次房室瓣手术能够避免正中开胸的风险,麻醉处理的重点包括术前评估、单肺通气、建立外周体外循环、注意心肌保护、避免体循环进气等。
Objective To summarize the experiences of anesthetic management for thoracoscopic reoperation for cardiac atrioventricular valves. Methods The anesthetic and perioperative data of patients who had undergone thoracoscopic reoperation for cardiac atrioventricular valves from January 2012 to December 2014 were reviewed retrospectively. All patients were given the combined intrave- nous and inhalation anesthesia with double-lumen endotracheal intubation. The peripheral cardiopulmonary bypass was set up through femoral arterial and venous cannulation and percutaneous superior vena cava cannulation. All operations were performed under thoracoscopy without aortic cross-clamping. Results Of the 25 patients studied,2 patients underwent the third time cardiac surgery, 11 underwent the second mitral valve replacement in which 2 had simultaneous tricuspid valve plasty and 1 had left atrial thrombus removal, 10 underwent the second tricuspid valve replacement and 4 underwent the second tricuspid valve plasty. The mean operation time was （3.3 ± 1.6） h. The mean cardiopulmonary bypass time was （96. 5 ± 26. 9 ） min. The meat~ lowest body temperature was （32.4 ± 1.5 ） ℃. Twenty patients underwent surgery with heart beating. There were 5 patients completing the operation under the condition of ventricular fibrillation. After the suture of incision,electric defibrillation was applied to recover the heart rhythm when the patients still had ventricular fibrillation. The mean mechanical Ventilation time, mean time of ICU stay and hospital stay postoperatively were （55.9 ± 114. 0） h, （ 105. 3 ± 158.6） h and （9. 5 ± 613 ） d, respectively. There were 6 cases having perioperative complications （24. 0% ）, and 3 died after operation （ 12. 0% ）. Conclusion The operation for cardiac atrioventricular valve with thoracoscopy can avoid the risk of median sternotomy. The key points of anesthetic management include preoperative evaluation, single lung ventilation, peripheral cardiopulmonary bypass, myocardial protection, and avoiding air into body circulation.
出处
《实用医院临床杂志》
2016年第1期13-16,共4页
Practical Journal of Clinical Medicine
基金
广东省医学科研基金资助项目(编号:A2015417
B2013004)
广东省科技计划项目(编号:2014 A020212403)
关键词
麻醉
体外循环
微创外科
再次心脏手术
Anesthesia
Cardiopulmoanry bypass
Minimally invasive surgery
Reoperation of cardiac surgery
