分段停循环下四分支人工血管替换全胸腹主动脉的麻醉处理

Anesthetic Management for One-stage Total Thoracoabdominal Aorta Replacement with Four Branch Vessel Prosthesis under Deep Hypothermic Caradiopulmonary Bypass and Subsection Circulatory Arrest

【目的】总结分段停循环下四分支人工血管替换全胸腹主动脉的麻醉处理经验。【方法】全胸腹主动脉替换术的麻醉处理21例,所有病人术前口服安定10mg,肌注长托宁1mg,吗啡10mg,静脉注射咪唑安定0.01～0.03mg/kg,依托咪酯0.1～0.3mg/kg,芬太尼5～10μg/kg,哌库溴铵0.1mg/kg麻醉诱导;间断给予芬太尼5～10μg/kg,哌库溴铵0.05mg/kg,吸入1%～2%异氟醚持续静脉输注异丙酚3～6mg·kg-1·h-1,维持麻醉。【结果】麻醉平稳,21例患者20例痊愈出院,术后早期死亡1例(病死率4.8%),神经并发症2例,经治疗痊愈,急性肾衰2例,经血透治疗痊愈。【结论】全胸腹主动脉替换术的麻醉处理效果良好。

[Objective] To summarize the experience in anesthetic management for one-stage total thoracoabdominal aorta replacement with four branch vessel prosthesis under deep hypothermie eardiopulmonary bypass and subsection circulatory arrest. [Methods] Anesthesia was done for 21 patients undergoing one stage total thoraeoabdominal aorta replacement. All patients were premedieated with oral diazepam 10 mg,and intramuscular morphine 10 mg and penehyelidine hydrochloride 1 mg anesthesia was induced with midazolam 0.01-0.03 mg/kg, etomidate 0.1-0.3 mg/kg fentanyl 5 - 10 μg/kg, pipeeuronium 0.1 mg/kg,and maintained with isoflurane inhalation and propofol infusion and intermittent iv. boluses of fentanyl and pipeeuronium. [Results] Hemodynamie suppession was mild during anesthesia. Twenty of the 21 patients were discharged from hospital, one patients died during the early post-operational period with a mortality of 4.8%. Two patients showed cerebral complications, and were cured after hydration therapy. Acute kidney dysfunction occurred in two patients and was cured by hemodialysis. [Conclusion] The anesthetie management for one-stage total thoraeoabdominal aorta replacement has an exeellent effeet.