犬肺移植手术麻醉的管理

Anesthesia for canine lung transplantation surgery

目的探讨犬肺移植外科手术的麻醉管理,为临床人体肺移植手术做准备。方法本组共完成16例犬肺移植麻醉,其中11例为自体肺移植,5例同种异体肺移植。供肺冷缺血时间为2-22 h。手术在气管插管全凭静脉全麻下完成,股动脉穿刺置管有创动脉监测血压,连续SpO2监测,定时抽动脉血行血气分析。分析调整呼吸参数,根据循环情况用血管活性药物。结果11例犬术毕麻醉苏醒,气管导管顺利拔出,能站立行走并存活4-72 h,有4例犬移植肺动脉开放后,1例犬麻醉苏醒拔出气管导管后发生急性肺水肿,体循环衰竭而死亡。犬肺移植后供肺早期换气功能良好。结论肺移植缺血再灌注损伤是早期发生肺功能损伤和急性肺水肿主要原因,经体液治疗,提高胶体渗透压,呼吸道的管理、血管活性药物的应用等措施可减少或延缓肺功能损伤和急性肺水肿的发生,以保证供肺换气功能。

Objective To acqaire experience for the clinical lung transplantation anesthesia.Methods Anesthesia for 16 canine lung transplantation were made,in which 11 were auto-lung transplantation,5 were allograft.The cold ischemia time was 2～22 hours.All the operations were underwent with intravenous anesthesia,and the blood pressure was controlled.Results 11 canine were revived and restored normal physiological function after 4～72 hours.One occured with acute pulmonary edema and died.Conclusion The ischemia-repertusion was the main cause of the pulmonary function injury and the acute pulmonary edema.