重症心脏瓣膜置换术的麻醉与心肌保护方法探讨

Research on the methods of anesthesia and cardiac muscle protection for severe patients with cardiac valve replacement

目的回顾80例重症病人行心脏瓣膜置换术的过程,总结体外循环麻醉与心肌保护方法的经验。方法麻醉随机分成两组,A组采用小剂量芬太尼、安定加肌松药静注,异氟醚间断吸入。B组为对照组,芬太尼、肌松药静注,异氟醚间断吸入。随机选择30例病人氧合血冠状动脉灌注用于心肌保护,另50例病人常规晶体停跳液灌注。结果A组诱导时,切皮时平均动脉压、心率波动范围小。开放升主动脉后含血停跳液组心脏自动复跳率明显高于晶体液停跳液组。结论麻醉诱导维持采用芬太尼小量分次静注,辅以安定,间断吸入异氟醚麻醉更为平稳。术中加强心肌保护,可减轻术后心功能衰竭,降低并发症和死亡率。

Objective To summarize the experiences in anesthesia and cardiac muscle protection in extracorporeal circulation. Methods The patients were randomly divided into two groups for anesthesia. Small doses of fentanyl, diazepam and muscle relaxant were used intravenously for group A, with addition of discontinuous inhalation of influrane. Fentanyl and muscle relaxant were used intravenously in group B, the control group, with addition of discontinuous inhalation of isoflurane. 30 eases were randomly chosen for coronary perfusion of oxygenated blood for cardiac muscle protection. The other 50 eases were perfused with routine erystalloid throb-ceasing solution. Results Ranges of average arterial pressure and heart rate of group A were smaller than those of group B during inducement and skin incision. The rate of automatic heart beat resumption of the group with blood-containing throb-ceasing solution was notably higher than that of the group with crystalloid throb-ceasing solution after the opening-up of ascending aorta. Conclusion Anesthesia induction with small-dose fentanyl fractionation aided with diazepam and discontinuous isoflurane inhalation can make anesthesia more stable. Strengthening cardiac muscle protection during surgery may relieve postoperative heart failure, and lower complications and death rate.