冠状动脉搭桥术合并射频消融术和瓣膜手术的麻醉

Anesthesia in radiofrequency catheter ablation combined with valve and coronary bypass surgery

目的：对冠脉搭桥同期行房颠射频消融术和心脏瓣膜手术的麻醉方法和效果进行总结和讨论。方法：冠脉搭桥同期行房颠射频消融术和心脏瓣膜手术26例，麻醉采用咪唑安定、异丙酚、芬太尼、异氟醚。结果：手术中升主动脉阻断时间平均（95．2±15．7）min，体外循环时间平均（150±19．8）min。术后呼吸机使用时间平均（15．5±4．1）h，ICU停留（1．2±0．4）d。术后平均住院时间（8．1±1．2）d。全组无住院死亡，出院后短期随访心功能Ⅰ～Ⅱ级，1例装永久起搏器。结论：在严密的术前准备和术中监护下行多个手术不仅减低了费用，而且减轻了多次手术创伤对患者的影响，本组冠脉搭桥同期行房颠射频消融术和心脏瓣膜手术的麻醉效果满意。

Objective To study the experience and results of anesthesia in radiofrequency catheter ablation combined with valve and coronary bypass surgery. Methods Twenty-six patients scheduled for radiofrequency catheter ablation combined with valve and coronary bypass surgery received intravenous-lnhalation anesthesia with midazolam, fentany, dlsoprofol and isoflurane. The clinical results of anesthesia were evaluated. Results The average durations of CPB and aortlc-clamplng were （150±19.8） and （95.2±15.7） minutes, respectively. The duration of postoperative ventilation was （15.5±4.1） hours. The median ICU stay was （1.2±0.4） days. The patients were discharged from hospital in （8. 1 ± 1. 2） days postoperatively. The cardiac function of the patients was improved significantly in the early follow up. No postoperative death occurred during hospitalization. A patient was installed permanent pacemaker. Conclusion In the appropriative preoperative preparation and the intra-operative intensive care, the expenses are reduced and the influence on patients＇wound is relieved during many operations. The anesthetic and operative outcomes of radiofrequency catheter ablation combined with valve and coronary bypass surgery are satisfactory.