腰椎间盘摘除术-肥厚性梗阻性心肌病-麻醉管理

Lumbar discectomy-hypertrophic obstructive cardiomyopathy-anesthesia management

肥厚性梗阻性心肌病为一类少见的特炭眭心肌病，表现为心肌非对称性肥厚，左室流出道狭窄，临床表现从无症状至猝死。对于1例肥厚性心肌病史10年，拟行腰椎间盘摘除术的患者，作者在充分熟悉肥厚性梗阻性心肌病的病理生理特征和心血管药物药理基础上，严格维护血流动力学的稳定，避免加重流出道梗阻的因素，维持适当的前后负荷，抑制过快心率和心肌收缩力，合理实施麻醉镇痛镇静，维持心肌氧供需平衡，保证了患者平稳度过围手术期。

Hypertrophic obstructive cardiomyopathy is a rare kind of idiopathic cardiomyopathy, includes asymmetric myocardial hypertrophy and left ventricular outflow tract obstruction. The clinical manifestations are from non-symptoms to sudden death. To a patient with hypertrophic obstructive cardiomyopathy who received lumbar discectomy, we tried our best to maintain the stabilities of hemodynamic parameters, avoided the factors which would deteriorate outflow tract obstruction, kept proper preload and post-load, slowed down the excessive heart rate and myocardial contraction force, gave effective analgesia and anesthesia drugs, maintained the balance of myocardial oxygen supply and consumption. All these measures helped the patient get over the perioperative period successfully.