胸腔镜下体外循环心脏手术的麻醉管理

Anesthetic management of thoracoscopic cardiac surgery with cardiopulmonary bypass

目的总结胸腔镜下体外循环心脏手术的麻醉管理经验。方法回顾性分析2011年1月至12月在广东省人民医院行胸腔镜下体外循环心脏手术患者的麻醉及围术期处理的相关资料。结果2011年我院共行胸腔镜辅助小切口或全胸腔镜下体外循环心脏手术85例,其中男30例,女55例,年龄(42.5±15.2)岁。手术类型包括:房间隔缺损修补术20例,同期三尖瓣成形术15例;左心房黏液瘤摘除术7例;二尖瓣成形术8例;二尖瓣置换术50例,同期三尖瓣成形术19例、心房颤动射频消融术5例、房间隔缺损修补术2例及左心房血栓清除术1例。麻醉均采用静吸复合全身麻醉,左侧双腔气管插管单肺通气,经皮上腔静脉插管、股动静脉插管建立外周体外循环,体外循环时间(151.8±63.6)min,心肌血运阻断时间(92.1±43.7)min。全组患者术后并发症8例(9.4%),死亡1例。结论良好的单肺隔离通气、充分的静脉引流以及完善的术中监测有利于手术的顺利进行,维持血流动力学平稳和避免缺血、缺氧可以减少围术期并发症,是胸腔镜下体外循环心脏手术麻醉管理的重点。

Objectives To summarize the anesthetic management experience for thoracoscopic cardiac surgery with cardiopulmonary bypass. Methods The patients underwent thoracoseopic cardiac surgery with cardiopulmonary bypass from January to December 2011 in Guangdong General Hospital were reviewed retrospectively. Results Totally 85 patients underwent video-assisted or totally thoracoscopie cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital in 2011, of who, 30 were male and 55 were female. The average age of the patients was （42.5 ±15.2 ） years old. The surgical procedures included 20 cases of atrial septal defect repair, 15 concomitant tricuspid valve plasty; 7 removal of left atrial myxomas; 8 mitral valve plasty; 50 mitral valve replacement, 19 concomitant tricuspid valve plasty, 5 concomitant radiofrequency ablation of atrial fibrillation, 2 auricular septal defect repair and 1 left atrial thrombectomy. All operations were performed through intravenous combined inhalation anesthesia with double-lumen endotracheal intubation. The femoral arterial and venous cannulation and percutaneous superior vena eava cannulation were used for peripheral cardiopulmonary bypass. Duration of cardiopulmonary bypass was （151.8±63.6） min and duration of myocardial ischemia was （92.1±43.7） min. Eight patients suffered from complications and 1 died after operation. Conclusions The key points of anesthetic management for thoraeoseopie cardiac surgery with eardiopulmonary bypass include one-lung ventilation, venous drainage and intraoperative monitoring. Maintenance of hemodynamie stability, avoidance of isehemia and hypoxia can reduce perioperative complications.