非体外循环下序贯式双肺移植的麻醉处理

Anesthetic management for bilateral sequential single-lung transplantation without cardiopulmonary bypass

目的探讨终末期肺病患者在非体外循环下进行序贯式双肺移植中的麻醉处理方式和注意事项。方法2例重度肺功能减退合并呼吸机依赖的终末期肺气肿患者和1例支气管扩张患者，手术均为非体外循环下序贯式双肺移植。麻醉诱导常规采用咪唑安定0．05～0．1mg／kg、芬太尼4μg／kg、依托咪酯0．2～0．4mg／kg及维库溴胺0．1mg／kg等药物；术中麻醉维持以静脉持续泵注异丙酚0．03～0．05mg·kg^-1·min。和维库溴胺1～2μg·kg^-1·min^-1术中严密监测各项生命体征，根据血气指标及生命体征调节机械通气参数，必要时行手控通气。结果3例患者手术过程较为顺利，分别于术后6、11、10d脱离呼吸机。术后肺功能明显改善，分别于术后第41、67、30d出院。结论充分的术前准备，合适的麻醉诱导和维持，术中全面的监测和术中对移植肺的保护等措施，是肺移植成功的关键因素之一。序贯式双肺移植术中应尽可能不使用体外循环。

Objective To discuss the management of anesthesia for bilateral sequential single lung transplantation for end-stage pulmonary disease without cardiopulmonary bypass. Methods Two cases of end-stage emphysema of pulmonary function with severe deterioration and ventilator-dependence preoperatively, and 1 case of bronchiectasis were subjected to bilateral sequential single lung transplantation without cardiopulmonary bypass. Anaesthetic induction was performed by midazolam （0. 05～0. l mg/kg）, fentany （4 vg/kg）, etomidate （0, 2～0, 4μg/kg） and vecuronium （0.1 mg/ kg）. Propofol （0. 03～0. 05 mg·kg^-1·min ） and vecuronium （ 1 ～ 2 μg·kg^-1·min） were administered for anaesthetic maintenance. Results The operation procedures of 3 cases were successful, and the recipients were weaned from ventilator on the day 6, 11 and 10 after operation, respectively. The lung function was improved significantly, and they were discharged from hospital on the day 41, 67 and 30 postoperatively. Conclusions Successful anesthesia for bilateral sequential lung transplantation was related with such factors： perfect pre-anaesthetic preparation, suitable induction and maintenance of anesthesia, the universal monitoring during surgery, stabilization of hemodynamics and adequate protection of allograft. Cardiopulmonary bypass should not be used as possible in anesthesia for bilateral sequential single-lung transplantation.