成年患者法洛四联症矫治术的麻醉处理

Anesthetic management for repair of tetralogy of Fallot in adults

本院1996年1月至2009年7月行法洛四联症矫治术患者235例，年龄18～54岁，男性123例，女性112例，年龄18—54岁，Hb122～263g／L，SpO2 67％～95％。术中监测有创血压、V导联心电图、CVP、SpO2、体温和经食道超声心动图。静脉注射咪达唑仑和／或依托咪酯、芬太尼和哌库溴铵麻醉诱导，气管插管后行机械通气。麻醉维持：吸入异氟烷或七氟烷、间断静脉注射芬太尼和哌库溴铵维持麻醉，轻症患者芬太尼用量为30ug／kg，重症患者芬太尼用量为50ug/kg。CPB结束后，给予相应的循环支持，同时加强血液保护和术后呼吸功能的支持。术中7例患者（2．9％）因缺氧发作需要紧急进行CPB，术后18例患者（7．6％）发生灌注性肺损伤，2例患者（0．9％）围术期行体外膜肺氧合辅助支持，术后3例患者（1．3％）死于严重低心排综合征或灌注性肺损伤。其余患者心功能及临床表现均明显改善。

Two hundred and thirty-five patients of both sexes （123 male, 112 female） aged 18-54 yr, weighing 35-62 kg underwent repair of tetralogy of Fallot from January 1996 to July 2009 in Fuwai hospital. Direct BP, ECG, CVP, SpO2, naso-pharyngeal temperature and TEE were continuously monitored during operation. Anesthesia was induced with midazolam and/or etomidate, fentanyl and pipecurenium and maintained with isoflurane/sevoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium. The total amount of fentanyl administered ranged from 30-50 ug/kg. Cardiac function was supported and hemodynamic stability was maintained with vasoactive and inotropic drugs. Measures were taken to strengthen blood conservation and respiratory function support. Seven patients （2.9%） needed urgent CPB during operation because of serious cyanotic spells. Perfusion-induced lung injury occurred in 18 patients （7.6%）. Circulation was assisted by ECMO in 2 patients （0.9%）. Three patients （1.3%） died of serious low cardiac output and perfusion-induced lung injury.