原位心脏移植手术的麻醉管理

Anesthesia Management on Orthotopic Heart Transplantation

目的探讨同种原位心脏移植手术麻醉管理的经验和方法.方法回顾分析2003年4月至2012年12月昆明市延安医院7例终末期心脏病患者的同种原位心脏移植手术.全麻诱导遵循分次小量渐增剂量的用药原则,麻醉维持采用芬太尼为主的静吸复合麻醉,体外循环下实施心肺联合移植手术.结果 7例患者麻醉过程平稳,手术过程顺利.例1、例2和例5患者生存至今,已分别存活10 a、9 a和5 a;例3患者术后存活1 a;例4和例6患者死于移植术后右心衰、急性排斥反应;例7患者死于停机困难、严重低心排.结论充分的术前准备,合理的麻醉方法和药物,维持围术期血流动力学稳定,及时有效处理右心功能不全和低心排是心脏移植手术麻醉成功的关键.

Objective To explore an effective method for anesthesia management on orthotopic heart transplantation. Methods 7 cases of end-stage heart disease who need orthotopic heart transplantation operation were retrospective analyzed in our hospital from 2003 April up to now. Induction of general anesthesia was followed the principle fraetionated small incremental doses of medication, and was maintained with combined intravenous anesthesia mainly with fentanyl. In the anesthesia management, the orthotopic heart transplantation operation was taken under the conventional extracorporeal circulation. Results Anesthesia process was stable, 7 cases were operated successfully. The patients of case 1, case 2 and case 5 survived until now （respectively 10, 9 and 5 years. Case 3 was survived for 1 year. Case 4 and case 6 died of right heart failure after transplantation and acute rejection. Case 7 died of shutdown difficulties, severe low cardiac output. Conclusion Sufficient preoperative preparation, rational choice of anesthetic methods and drugs, stable perioperative haemodynamic parameters, timely detection and treatment of right heart dysfunction and low cardiac output are key factors for successful anesthesia management on orthotopic heart transplantation.