新生儿完全性大动脉转位大动脉调转术的麻醉处理

Anesthesia management of arterial switch operation for newborns with complete transposition of great arteries

目的探讨新生儿完全性大动脉转位行大动脉调转术的麻醉管理。方法 14例完全性大动脉转位的新生儿,在气管插管全麻、体外循环(CPB)下行大动脉调转术,麻醉采用间断予芬太尼、咪达唑仑和维库溴铵维持,主动脉开放后给予多巴胺、米力农等血管活性药物,维持血流动力学稳定。结果全组麻醉平稳,CPB转流时间186～392(237.1±42.3)min,主动脉阻断时间126～201(139.5±34.2)min,术后呼吸机支持时间24～342 h。术后并发低心排综合征3例,死亡2例,延期关胸5例,低氧血症4例,肺部感染、急性肾功能衰竭各2例。结论新生儿大动脉调转手术麻醉危险性高,术中加强左室功能支持,维持血流动力学平稳,重视肺部并发症处理是麻醉管理重点。

Objective To explore the anesthesia management of arterial switch operation（ASO） in newborns with complete transposition of great arteries（TGA）. Methods Fourteen newborns with complete TGA underwent ASO under endo- tracheal intubation general anesthesia and cardiopulmonary bypass （CPB）. The fentanyl, midazolam and vecuronium were intermittently used to maintain anesthesia. After opening the aorta, dopamine, milrinone and other vasoactive drugs were given to maintain hemodynamic stability. Results The anesthesia was stable in all the sick newborns. The shunt time of CPB was 186 - 392 （237.1 ± 42.3 ） rain; blocking time of aorta was 126 - 201 （ 139.5 ± 34.2） min; supporting time of respirator post operation was 24 -342 h. Postoperative low cardiac output syndrome occurred in 3 cases, and in them 2 cases died;delayed sternal closure occurred in 5 cases; hypoxemia occurred in 4 cases ; pulmonary infection occurred in 2 cases; acute renal failure occurred in 2 cases. Conclusions The anesthesia of neonatal ASO has a higher risk. Strengthening the support to left ventricu- lar function,maintaining hemodynamic stability and paying attention to the treatment of pulmonary complications are the foci of anesthesia management.