非体外循环下序贯式双肺移植的麻醉处理

Anesthetic Management for Bilateral Sequential Single-lung Transplantation Without Cardiopulmonary Bypass

【目的】探讨终末期肺部疾病患者在非体外循环下进行序贯式双肺移植中的麻醉处理方式和注意事项。【方法】1例矽肺Ⅲ期、肺气肿并多发肺大疱、严重肺功能不全的患者行非体外循环下序贯式双肺移植。麻醉诱导常规采用咪达唑仑0．05～0．1mg／g、芬太尼8μg／kg、维库溴铵0．2mg／kg及丙泊酚0．4mg／kg等药物，术中麻醉维持以静脉持续泵注丙泊酚0．01～0．08mg／（kg·min）、瑞芬0．01～0．1μg／（kg·min），间断静脉注射芬太尼及维库溴铵。术中严密监测各项生命体征，根据血气指标及生命体征调节机械通气参数，必要时行手控通气。【结果】手术过程顺利，麻醉平稳，于术后49h拔除气管插管，8d转出ICU，术后27d康复出院。【结论】麻醉前充分准备、合适的麻醉诱导和维持、术中全面监测、对移植肺的保护等措施是麻醉成功的关键。

[Objective] To discuss the anesthetic management for bilateral sequential single lung transplantation for end-stage pulmonary disease without cardiopulmonary bypass. [Methods]One case of end-stage sili cosis and emphysema complicated with bunamiodyl and severe pulmonary function insufficiency was subjected to bilateral sequential single lung transplantation without cardiopulmonary bypass. Anesthetic induction was performed by midazolam（0. 05～0. 1 mg/ kg）, fentanyl （8μg/ kg） , propofol （0. 4mg/kg） and vecuronium bromide （0. 2mg/kg）. Propofol [0. 01～0.08mg/（kg·min ）1 and remifentanil [0.01～0.1μg/（kg·min）] were administered for anesthetic maintenance and disconnected intravenous injection of fentanyl and vecuronium bromide. [Results]The operation was successful , and the recipient was weaned from ventilator on 49 hours, and shifted out from ICU on 8 days, and discharged from hospital on 27 days after operation. [Conclusion] Successful anesthesia for bilateral sequential lung transplantation is related with such factors as perfect preparation of anesthesia, suitable induction and maintenance, universal monitoring during surgery and ade quate protection of allograft.