食管超声引导下经右心室穿刺室间隔缺损封堵术的麻醉管理

Anesthetic management for perventricular closure of ventricular septal defect under transesophageal echocardiography

目的：探讨食管超声引导下经右心室穿刺室间隔缺损封堵术的麻醉体会。方法对52例行食管超声引导下经右心室穿刺室间隔缺损封堵术患儿的临床资料进行回顾性分析，均采用气管插管全身麻醉，监测心电图、脉搏血氧饱和度、有创动脉压、中心静脉压、呼吸末二氧化碳分压、体温及尿量等，术中食管超声辅助穿刺导航、封堵伞释放等。结果51例患儿成功完成食管超声引导下经右心室穿刺室间隔缺损封堵术，手术时间（76.7±36.4）min，麻醉时间（89.5±27.1） min；1例患儿改行体外循环下室间隔缺损修补术。结论术中食管超声技术是该手术成功的关键，麻醉医生在镇痛镇静的同时，需要关注患儿血流动力学的变化。

Objective To investigate the anesthetic management of perventricular closure of ventricular septal defects （VSD） under transesophageal echocardiography. Methods A retrospective review of the clinical data of 52 children who underwent perventricular closure of VSD under transesophageal echocardiography were analyzed. All the children were performed tracheal intubation under general anesthesia, and the electrocardiogram, pulse blood oxygen saturation, invasive arterial pressure, central venous pressure, end tidal carbon dioxide partial pressure, temperature and urine output were continuously monitored throughout the procedure. The transesophageal echocardiography was necessary for guiding transcatheter or per-ventricular device placement. Results Perventricular closure of VSD was successfully completed in 51 children under transesophageal echocardiography, the operation time was （76.7 ± 36.4） min, the anesthesia time was （89.5 ± 27.1） min; 1 child was converted to open surgical repair. Conclusions The intraoperative transesophageal echocardiography technology is the key to the success of the surgery. At the same time of analgesia and sedation, the anesthesia doctor needs to pay attention to the changes of hemodynamics in children.