33例完全性肺静脉异位引流手术麻醉处理.doc

33例完全性肺静脉异位引流手术麻醉处理
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作者:蒋怡燕,乔彬,吴莉莉,段文元,鞠吉峰,林晓娜,徐军
【摘要】目的研究完全性肺静脉异位引流围术期麻醉处理。方法 2005年1月至2008年2月完全性肺静脉异位引流手术共33例,男20例,女13例,年龄20天~1岁,其中新生儿6例,1~6个月22例,6个月~1岁5例, mg/kg。开放静脉通道,麻醉诱导后鼻腔内气管插管,左侧桡动脉穿刺测有创血压,右侧深静脉置双腔管,静吸复合麻醉,芬太尼、维库溴铵维持麻醉。压力控制呼吸,呼气末正压2~3 mmHg。使用正性肌力药支持体外循环前后循环功能。结果全组围术期麻醉平稳顺利,其中6例急诊抢救,6例急诊手术。30例为中低温下手术,3例深低温停循环下手术。给正性肌力药后主动脉开放全部自动复跳,顺利撤离体外循环。术后4~6 h麻醉清醒,24~72 h拔掉气管插管,除1例因术后低心排死亡,余均术后恢复顺利,康复出院。结论完全性肺静脉异位引流术麻醉只要避免心肌抑制,合理用药,加强监测,能降低麻醉风险。
【关键词】完全性肺静脉异位引流;围术期;麻醉处理
Abstract: OBJECTIVE To investigate the perioperative anesthesia management of patients with total anomalous pulmonary venous connection (TAPVC). METHODS Between Jan 2005 to Feb 2008, 33 cases with TAPVC (20 males, 13 females) aged from 20 days to 1 years were performed operations. Midazolam ( mg/kg) was administrated orally half an hour before operation. Tracheal intubation was performed via nasal cavity after anesthesia induction. Anesthesia was maintaining with fentanyl, vecuronium and isoflurane. Mechanical ventilation was set to pressure controled volume mode with positive end expiratory pressure (2 to 3 mmHg). Stable hemodynamics of patients pre- and post- cardiopulmonary bypass (CPB) was achieved with infusion of inotropic agent. RESULTS The anesthesia for all patients was essful. 30 cases were performed operations with moderate hypothermia C