降主动脉缩窄手术的麻醉处理

The Anesthesia Management of the Descending Aortic Coarctation Operation

目的总结和探讨23例降主动脉缩窄手术的麻醉处理方法。方法23例降主动脉缩窄患者在控制性降压及降温麻醉下行主动脉缩窄矫正术。麻醉采用芬太尼为主的静吸复合全麻,麻醉中同时监测上下肢血压,并应用微量泵静注硝普钠控制血压。结果麻醉诱导及阻断主动脉前上肢收缩压维持在100-130mmHg,下肢收缩压80-100mmHg,阻断主动脉时间16-48（32）min。阻断主动脉期间上肢收缩压波动在100-130mmHg之间,下肢收缩压40-52 mmHg。开放主动脉后上肢血压无明显降低。全组未发生与麻醉相关的并发症。结论降主动脉缩窄手术的麻醉处理重点在于控制性降压和适当的降温,并应严防急性心衰、心跳骤停、截瘫、急性肾功能衰竭等并发症的发生。

OBJECTIVE To summarize the anesthesia feature of aortic coarctation operation.METHODS 23 patients with descending coarctation of aorta were underwent surgical treatment with the controlled hypotension and hypothermy anesthesia.Intravenous-inhalation combination anesthesia was used mainly with fentanyl.Upper and lower extremities blood pressure was monitored simultaneously.Blood pressure was controlled by sodium nitroprusside continuously.RESULTS Upper extremities systolic blood pressure（SBP） held 100-130 mmHg and lower extremities SBP held 80-100 mmHg before anesthesia induced and cross-clamp aorta.The aorta cross-clamp time was 16-48 min（average time was 32 min）.Upper extremities blood pressure was not depressed obviously.All patients didn＇t happen complication correlation with anesthesia.CONCLUSION The anesthesia emphasis of the descending aortic coarctation operation is controlled-hypotension and suitable hypothermy.The complication of acute congestive heart failure,paraplegia and acute renal failure must be prevented.