心脏瓣膜替换术的麻醉处理

The anesthetic treatment of valve replacement of valvular heart disease

目的 探讨心脏瓣膜替换术的麻醉处理特点。方法 麻醉诱导采用咪唑安定、芬太尼、依托咪酯、维库溴铵 ,麻醉维持采用静吸复合麻醉。连续监测ECG、BP、CVP、SpO2 、体温、尿量、电解质、血气。心肌保护采用 4℃高钾晶体停搏液、持续温氧合血灌注。结果 36 5例手术围术期血流动力学稳定。心脏自动复跳 2 74例 ,自动复跳率达 75 %。无麻醉死亡。结论 心脏瓣膜手术的麻醉宜选用对血液动力学影响小 ,心肌抑制轻的药物 ,芬太尼、咪唑安定、依托咪酯是其主要用药。诱导和CPB是最关键的步骤之一。围术期应合理应用血管活性药 ,维持血流动力学的稳定。

Objective To discuss the behavior of anesthesia and treatment in perioperative period of valve replacement of valvular heart disease. Methods The drugs of anesthesia induction included midazolam,fentanvl,etomidate and vecuronium. Compound anesthesia and trachea intubation was taken. Continuous monitored the ECG,BP,CVP,SPO2,body temperature,urine volume,electrolure,blood gas. 4℃ high potassium crystal fluid and continuous thermooxygenative blood filling were used for myocardial preservation. Results In all 365 cases hemodynamics in perioperative period was stable. The heart autobeated in 274 cases. And the rate was 75%. There was no anesthetic death. Conclusion The drugs which did not seriously influence hemodynamics and myocardium fit the valve replacement of valvular heart disease. And fentanvl,midazolam and etomidate were main drugs. Induction and CPB was key process. the drugs with angioactivity should be used reasonably in perioperative operiod to make hemodynamics stable.