电视胸腔镜下小儿室缺矫治术的麻醉管理

Anaesthesia management of thoracoscopic surgery for ventricular septal defect in pediatrics

目的探讨小儿电视胸腔镜下室缺矫治术的麻醉管理方法。方法61例先天性心脏病患儿,年龄3～13岁,均采用单腔气管内插管全麻,整个手术过程通过改良双肺通气方法来暴露术野,分次给予芬太尼镇痛,微泵静注维库溴铵维持肌肉松弛,并根据需要间断吸入异氟醚维持麻醉。结果全组均未出现恶性心律失常、残余漏及低心排出量综合征等并发症。体外循环时间、主动脉阻断时间及术后呼吸支持时间与同期常规正中开胸组相比,差异无统计学意义(P>0.05);而术后胸液量、输血量及住院时间明显缩短(P<0.01)。结论电视胸腔镜下小儿先天性心脏病手术,术中改良双肺肺通气,加强呼吸管理和肺保护是麻醉管理的关键。

Objective To summarize anaesthesia management of thoracoscopic cardiac surgery in pediatric ventricular septal defect. Methods 61 patients, 3-13 years old, with congenital-heart diseases, were operated by thoracoscopic approach. Anaesthesia were performed through single-cavity tube in the trachea, changing ventilate methods to exposure the operation area, giving fentanyl times to ease pain, giving vecuronium through tiny-pump to maintain muscle relaxation, inhaling disconnectedly isoflurane to maintain anaesthesia . Results There was no operative complications such as death,leak, arrhythmia and low heart out-put syndrome. The time of bypass, cross-clamped and ventilation were similar to other 38 cases operated through a mediam sternotomy at the same period（P〉0.05）, but the volume of drainage and time of hospitalization were significantly less （P〈0.01）. Conclusion Changing ventilate methods to expose operation area, strengthen the breathe manage and lung protection are the key of anaesthesia manage for thoracoscopic cardiac surgery in congenital heart diseases.