胸壁打孔胸腔镜体外循环下小儿先天性心脏病手术麻醉体会

Experience of anesthesia in patients with pediatric congenital heart disease undergoing video-assisted thoracoscopic cardiac surgery with cardiopulmonary bypass

目的探讨小儿胸壁打孔胸腔镜体外循环下心脏手术的麻醉管理方法。方法选取同期行胸腔镜手术(A组)和常规正中开胸心脏手术(B组)的小儿,年龄3～13岁,体重13～30 kg,ASAⅡ～Ⅲ级。均为先天性心脏病。其中A、B两组各60例。均采用全身麻醉单腔气管插管中低温体外循环下手术。记录两组手术相关时间、术中血液动力学的变化情况、血气分析等。结果两组患儿手术顺利,无重要并发症。A组与B组在诱导后、转机前、停机后和手术结束等时间点上各血液动力学指标无显著性差异(均P>0.05)。两组抽动脉血气检测,各项指标在正常值范围,无显著性差异(均P>0.05)。A组患者体外循环转流时间、主动脉阻闭时间及手术时间均比B组明显延长(均P<0.05),而术后机械通气时间I、CU停留时间均短于开胸组(P<0.01和P<0.05)。结论电视胸腔镜体外循环下小儿先天性心脏病手术,术中全面监测,改良双肺通气以及加强呼吸管理和加强肺保护是麻醉管理的关键。

Objective To investigate anesthesia management in patients with pediatric congenital heart disease undergoing thoracoscopic cardiac surgery with cardiopulmonary bypass.Methods 120 patients with ASA gradeⅡ-Ⅲscheduled for cardiac surgery under general anesthesia requiring intubation and hypothermic cardiopulmonary bypass（CPB） were randomly allocated equally to video-assisted thoracoscopic cardiac surgery group（group A,n=60） and open cardiac surgery group（group B,n=60）.Operation time,the parameter indexes of hemodynamics were measured and arterial blood gas analysis was performed.Results All patients were successfully received cardiac surgery without any complication.There was significant difference in the parameter indexes of hemodynamics and arterial blood gas analysis comparing two groups at different time points（all P0.05）.Aortic clump time and CPB time were greatly longer in the group A than group B（all P0.05）.The postoperative mechanical ventilation time and the intensive care unit（ICU） residence time in group A were shorter than group B（P0.01 and P0.05）.Conclusion The lung protective ventilatory strategies and intra-operative monitor were the key points in the anesthetic management of patients with pediatric congenital heart disease undergoing video-assisted thoracoscopic cardiac surgery with cardiopulmonary bypass.