机器人冠脉搭桥手术的麻醉

Investigation of anesthesia for robotic assisted coronary artery bypass grafting

目的:对da Vinci机器人冠脉搭桥手术的麻醉要求和管理方法进行探讨。方法:2007年1-9月我院完成机器人冠脉搭桥手术16例,采用全麻双腔支气管插管,在右侧单肺通气和左侧CO2气胸下进行手术,术中常规行经食道超声(TEE)、血流动力学和血气监测。结果:15例患者由机器人辅助完成左乳内动脉游离后,经左侧肋间小切口,直视下完成血管吻合;1例全机器人手术由机器人完成左乳内动脉游离和血管吻合全过程。多数患者能够耐受单肺通气和CO2气胸,但1例全机器人手术中,患者出现低氧和高碳酸血症并引发心动过速。术后拔管时间平均4.72 h,ICU停留时间1.2 d,术后平均住院日6.6 d。术后并发1例房颤和1例肺不张。结论:对于机器人冠脉搭桥手术,麻醉的关键是预防和处理单肺通气和CO2气胸引起的缺氧和血流动力学波动。

Objective：Robotic assisted coronary artery bypass grafting（RACAB） surgery is a fast-developing technique with the use of the da Vinci surgical system. The anesthesia for RACAB was investigated which is technically more challenging. Methods： Between January 2007 and September 2007, 16 RACAB surgeries on beating heart were performed at our institution with the da Vinci surgical system. With the standard general anesthesia, a double-lumen endotracheal tube was positioned to allow single right-lung ventilation. TEE, hemodynamics and blood gas were routinely monitored. Results： In 15 patients, left internal thoracic artery grafts were harvested with robotic assistance, and anastomoses were manually constructed through a small thoracotomy incision. In one other patient, totally endoscopic coronary artery bypass grafting（TECAB） was performed with the robotic system. Although single-lung ventilation and CO2 pneumothorax were well tolerated in most patients, the sole patient to receive TECAB showed hypoxemia and hypercapnia, as well as a compensatory increase in heart rate. The period from completion of surgery to extuhation averaged 4.72 hours. The average length of ICU stay was 1.2 days and post-operative hospital stay was 6.6 days. The complications included 1 patient with atrium fibrillation and 1 patient with atelectasis. Conclusion： The key point of anesthesia for RACAB is to deal with hypoxemia and undulated hemodynamics as a result of single right-lung ventilation and CO2 pneumothorax.