心脏瓣膜置换手术的麻醉处理

Anesthesia management for cardiac valve replacement

目的观察97例心脏瓣膜王换手术围术期麻醉效果。方法97例心脏瓣膜病变患者，麻醉诱导采用咪唑安定0．1～0．3mg·kg^-1,芬太尼3～5μg·kg^-1、堆库溴铵0．1mg·kg^-1诱导，麻醉维持用芬太尼30～40μg·kg^-1、维库溴铵0．1mg／（kg·h）。术中、术后适量给予血管活性；物支持循环功能。结果麻醉诱导期心率与诱导前比较无明显变化（P〉0．05），而血压降低有显著性差异（P〈0．05）。死亡7例，死亡率7．21％。结论心脏瓣膜置换手术麻醉的关键是保持适当心率，在围术期尤其是在CPB前尽量维持有效的心输出量，术中、术后适量给予血管活性药物支持循环功能。

OBJECTIVE To summarize the experiences on the anesthesia management of cardiac valve replaccment. METHODS 97 patients were induced with midazolam 0. 1- 0. 3mg·kg^-1, fentanyl 3 -5μg·kg^-1,and vecuronium 0. 1mg·kg^-1 were maintained with fentanyl 30- 40μg·kg^-1 and vecuronium 0. 1 mg/ （kg · h）. Vasoactive drugs were used introperatively and postperatively when necessary to support the circulation. RESULTS There were little changes in HR during and pre-anesthesia（P〉0. 05） ,hut BP decreased significantly （P〈0.05）, 1 patient died introperatively and 6 patients died postperatively. CONCLUSION Keep the effective HR and CO is the key of anesthesia treatment in cardiac valve replacement. Introperatively and postperatively,Vasoactive drugs therapy should he given appropriately.