心脏瓣膜置换术的麻醉

ANESTHESIA FOR CARDIAC VALVE REPLACEMENT

心脏瓣膜置换术的麻醉,是在心内直视手术的麻醉基础上发展起来的。二十年来我院给合自己的经历,开始以吸入全麻为主,而后进展到静脉复合全麻,终于采用吗啡复合全麻;吗啡的用量先自3±毫克/公斤减至1±毫克/公斤,积有不少成功和失败的经验,现总结心脏瓣膜置换术的麻醉,供不断提高和改进中作参考。

Intravenous balanced anesthesia,with morphine or fentanyl as a main component,had been applied in 40 operations of cardiac valve replaoment.Among them 30 cases were mitral valves while the another 10,aortic valves.During and after such anesthesia,the influences involving the cardiovascular functions especially the myocar-dial contractility were the least.Whenever hypertension occurred during the incision of the skin or through the extracorporeal perfusion,inhalation of halothane or intravenous injection of regitine should be given accordingly.Under the effects of soopolami-ne,diazepam,droperidol,pethidine and/or sodiumγ-hydroxybutyrate,the dose of morphine was as a rule limited within 1 mg/kg.The use ofγ-hydroxybutyrate however should be cautious in patients with acquired cardiac disease.The effect of morphine was much longer than fentanyl.Anesthesia consisting the former would usually last along 8 hours,while the latter an hour or so.Balanced anesthesia with proper combination of morphine and fentanyl gave the least difficulty to keep the patients waking up within 3-4 hours after operation.Needles with external cannula,made by tetrafluoro-ethylene plastic,were used routinely in these 40 cases to measure either the mean arteral or the central venous pressures.Punctures of the radial arteries and/or the internal jugular veins through the skin were Safe and well successful following some practice.Endotracheal intubation through the nostril was accepted routinely for respiratory management postoperatively.No adverse reaction has ever been noted even when the intubation lasted for 3-5 days.Tracheostomy had to be avoided as much as possible.