完全性大动脉转位行大动脉调转术16例麻醉分析

Anesthesia management of 16 complete transposition of great arterial patients with arterial switch operation

目的总结完全性大动脉转位行大动脉调转术的麻醉处理体会。方法回顾性分析16例完全性大动脉转位行大动脉调转术的麻醉资料。全组患儿均在中低温低流量体外循环下行大动脉调转术及冠状动脉移植术。人室后肌注氯胺酮行基础麻醉，麻醉药物选用芬太尼、咪达唑仑和维库溴铵，术中监测心电图、动脉血压、中心静脉压、左房压、体温、经皮血氧饱和度、呼气末二氧化碳、尿量和血气分析等，主动脉开放后给予多巴胺、肾上腺素、硝酸甘油、米力农、异丙肾上腺素等血管活性药以维持血流动力学稳定，根据中心静脉压和左房压控制体外循环后液体回输速度。结果麻醉经过平稳，无麻醉并发症。术中2例死于重度低心排，不能脱离体外循环。结论完全性大动脉转位患儿年龄小，全身情况及心功能差，充分的术前准备、平稳的麻醉诱导及维持、正性肌力药及血管扩张药的合理使用是顺利完成手术的关键。

Objective To summarize anesthesia management of arterial switch operation. Methods The clinical date of 16 patients with complete transposition of great arterial who underwent corrective operation was analyzed retrospectively. The operation was carried out under hypothermia circulatory arrest and low flow perfusion. Ketmine were injected into the patients through IM to perform anesthetic inducement. Anesthesia was induced with midazolam,fentanyl, vecuronium. ECG, IBP, CVP, LAP, T, SpO2,PErCO2, Urinary Volume, Blood Gas Analysis were monitored. Dopamine,Adrenaline,Nitroglycerin,Milrinone,Isoprenaline were intravenous infusion after aortic unclamping to maintain the homodynamic stability. The rate of infusion was adjusted by LAP and CVP to avoid circulatory overload. Results All patients were completed surgery without anesthesia complications, there were 2 patients died from low cardiac output after operation. Conclusion Physical fitness and cardiac function are different in the patients of complete transposition of great arterial. Sufficient preoperative preparation, steady anesthesia induction and maintenance, properly using positive inotropic and vasodilator are the key to complete surgery smoothly.