完全性大动脉错位解剖纠治手术的麻醉管理

Anesthetic management of anatomic correction for TGA.

总结了８例完全性大动脉错位（ＴＧＡ）解剖纠治术的有关麻醉管理的若干问题。其中４例室隔完整，４例伴室缺。最小年龄１８天，最轻体重３．４ｋｇ。采用大剂量芬太尼伴以安氟醚静吸复合麻醉。５例深低温停循环，３例低温体外循环，主动脉阻断时间９７．５±２０．８７分钟，全部自动复跳，１例死于肺高压，无麻醉并发症。大剂量芬太尼可使整个麻醉和手术过程较为平稳。术毕仍应维持适当麻醉深度，以利术后血流动力学平稳。变力性药物有助于心功能恢复，常用多巴胺。体外循环中按 α稳态的理论调节ｐＨ和 ＰａＣＯ２，无一例神经系统并发症。

Some problems of anesthetic management for switching operation with TGA in 8 cases were summarized including TGA/IVS 4 cases, and TGA/VSD 4 cases, aged lowest 18 days, weighed lowest3. 4 kg. A smooth course during anesthesia and operation with high- dose fentanyl and ethrane could be resulted. Appropriate degree of anesthesia should be maitained at the end of operation in order to keep hemodynamic stabilization postoperatively. Inotropic drugs contributed to resumption of cardiac function, in which dopamine was the first choice. Because of adjustment of pH and PaCO2 according to the theory of a-steady state during CBP, there were no anesthetic complication and no neurologic complication after circulatory arrest with deep hypothermia.