心脏肿瘤切除术的麻醉管理

Anesthetic management for primary cardiac tumors surgery

目的探讨心脏肿瘤切除术的麻醉管理方法。方法回顾性分析28例心脏肿瘤手术切除患者的麻醉处理情况,其中左房黏液瘤18例,右房黏液瘤5例,横纹肌瘤2例,其他肿瘤3例。患者均行开胸手术。麻醉诱导采用咪达唑仑,舒芬太尼及哌库溴铵静注。麻醉维持给予间断注入舒芬太尼及咪达唑仑,并酌情吸入异氟烷辅助麻醉。结果麻醉诱导时发生低血压者6例(21.4%);体外循环(CPB)前发生高血压者2例(7.1%),窦性心动过缓6例(21.4%),心房纤颤者5例(17.9%);CPB后发生低血压6例(21.4%),心动过缓4例(14.3%),以上症状经用药物处理后得到控制。其余患者麻醉诱导、维持平稳。结论心脏肿瘤患者需加强麻醉前评估,选择合理的麻醉药物,避免血流动力学剧烈波动。

Objective To summarize the experience in anesthetic management for surgery of cardiac tumors. Methods A total of 28 patients with cardiac tumors who underwent surgical treatment in our hospital were retrospectively summarized for their anesthetic management. The primary cardiac tumors in this group included eighteen cases of left atrial myxoma, five of right atrial myxoma, two of rhabdomyoma and three of others. General anesthesia was induced with midazolam, sulfentanil and pipecuronium, and maintained with isoflurane inhalation and intermittent iv. midazolam and sulfentanil. Results The anesthetic course was generally smooth. Hypotension occurred in six cases during anesthetic induction. Two cases with hypertension, six cases with sinus bradycardia and 5 cases with atrial fibrillation were observed before cardiac-pulmonary bypass. Six cases with hypotension and four cases with bradycardia were found after CPB. Conclusion The key points for the anesthetic management of cardiac tumors include precise preoperative evaluation, steady hemodynamic and reasonable medications.