胸主动脉夹层动脉瘤腔内隔绝术的麻醉管理

Anesthesia for endovascular stent-graft implantation of thoracic aortic dissection

目的探讨胸主动脉夹层动脉瘤实施腔内隔绝术的麻醉方法及麻醉管理要点。方法 29例胸主动脉夹层动脉瘤患者均在静吸复合全身麻醉和控制性降压下实施手术,麻醉诱导采用咪唑安定、丙泊酚、芬太尼及阿曲库铵,麻醉维持采用丙泊酚、芬太尼、阿曲库铵、异氟烷或七氟烷。术中持续监测心电图、有创动脉血压、中心静脉压、脉搏血氧饱和度、呼气末二氧化碳分压及尿量,必要时监测动脉血气、电解质及血糖等。支架释放时微泵输注硝酸甘油0.5～5μg/(kg.min),使收缩血压控制在90～100mmHg。结果所有麻醉效果满意,麻醉时间(120.28±15.25)min,术中血压维持平稳,支架释放时平均动脉压控制在(65.13±14.32)mmHg,无任何麻醉并发症发生。结论充分的术前准备,术中控制降压及重要脏器功能保护是胸主动脉夹层动脉瘤腔内隔绝术麻醉管理的关键与重点。

Objective To present the anesthetic management of patients for endovascular stent-graft implantation of thoracic aortic dissection.Methods Twenty-nine patients with thoracic aortic dissection were underwent endovascular stent-graft implantation under combined intravenous-inhalation anesthesia and controlled hypotension.Anesthesia was induced with midazolam,propofol,fentanyl and atracurium,and maintained with propofol,fentanyl,atracurium,isoflurane or sevoflurane.Continuous electrocardiogram,invasive blood pressure,central venous pressure,percutaneous oxygen saturation,end-tidal carbon dioxide tensions and urine output were monitored.Arterial blood gas,plasma electrolyte and blood sugar were monitored if necessary.An intravenous infusion of nitroglycerin[0.5～5 μg/（kg·min）] was given to maintain systolic pressure at 90～100mmHg before release of the stent.Results The anaesthesia times were（120.28±15.25） minutes.The anesthetic effects were satisfactory and the hemodynamics was steady.Before release of the stent,mean arterial blood pressure was reduced to（65.13±14.32） mmHg.All of them had no anesthesia complications.Conclusion Appropriate preoperative preparation,controlled hypotension and systemic organ protection are very important in the anesthetic management of patients for endovascular stent-graft implantation of thoracic aortic dissection.