单纯主动脉瓣重度狭窄患者瓣膜置换术的麻醉处理

Anesthetic management during cardiac valve replacement in the patients with single serious Aortic Stenosis

目的探讨重度主动脉瓣狭窄瓣膜置换术的麻醉处理方法。方法收集我院近年这类患者36例进行总结与分析,探讨这类患者的麻醉处理方法。结果1例麻醉前用药引起血压下降,4例在麻醉诱导时平均动脉压下降至50mmHg以下,均需处理。7例在打开主动脉阻断钳10min后心脏才复跳。11例带临时起搏器送入ICU,其中1例术后顽固性心动过缓,带永久性起搏器出院。36例患者全部顺利送入ICU,最后治愈出院。平均带管时间16.4±9.6小时,ICU停留时间为2.2±1.7天,术后住院时间8.7±4.6天。结论(1)术前用药剂量宜偏小。(2)维持窦性心律很重要。(3)心率最好维持在70～90次/分。(4)在可能情况下要适当提高前负荷,保持足够血容量,以增加每搏输出量。(5)最好不使用增强心肌收缩力或增加室壁张力的药物。(6)主动脉阻断时间不宜太长等。

Objective To analyze the Anesthetic management during cardiac valve replacement in the patients with single serious Aortic stenosis. Methods A retrospective study was carried out in consecutive 36 patients with （the pure aorta petal） in my hospital inquirying into the anesthesia management of the patients with this disease. Results with the premedication the blood pressure have a serious descend in one patient. The blood pressure declined to 50 mmHg with induction in four patients. The heart returned to pump after 10 min and over when aorta declamping in seven patients, et al. Conclusions （1） Using little premedication dose. （2） A normal sinus rhythm is very beneficial. （3）The moderate heart rate had better maintain at 70-90bpm. （4） Keep the enough blood capacity when needs, et al.