肥厚型心肌病患者行非心脏手术的麻醉管理

Anesthesia management for patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery

目的总结肥厚型心肌病(HCM)患者行非心脏手术的麻醉管理经验。方法回顾性分析2010年1月至2019年9月在西京医院行非心脏手术的36例HCM患者的临床资料。结果 36例患者均为非梗阻性HCM患者,均顺利安全完成外科手术,术中血流动力学基本平稳。除1例剖宫取胎术患者因术前合并多源性室性早搏伴短阵房性心动过速术后转重症监护室治疗外,其余患者均安全返回病房,术后无不良心血管事件发生。结论非梗阻性HCM患者可安全行非心脏手术,麻醉原则是保证足够的麻醉深度,充分保证心脏的前负荷和后负荷,维持满意的心率和血压,同时避免加重左室流出道梗阻的因素。

Objective To summarize the experience of anesthetic management in patients with hypertrophic cardiomyopathy(HCM) undergoing non-cardiac surgery. Methods Clinical data of 36 patients with HCM undergoing non-cardiac surgery in Xijing Hospital of Air Force Medical University of PLA from January 2010 to September 2019 were retrospectively analyzed. Results All the 36 patients with non-obstructive HCM completed the surgery successfully and safely, with stable hemodynamic during surgery. Except one patient who had undergone cesarean section of a death fetus was transferred to intensive care unit as her preoperative electrocardiogram showed multifocal premature ventricular contractions and short atrial tachycardia, all other patients returned to the wards and no adverse cardiovascular events occurred after surgery. Conclusion Patients with non-obstructive HCM can safely undergo non-cardiac surgery. The principles of anesthesia management for HCM patients undergoing non-cardiac surgery can be listed as follows: ensuring sufficient anesthetic depth, maintaining adequate cardiac preload and afterload, keeping satisfactory heart rate and blood pressure, and avoiding factors that may aggravate left ventricular outflow tract obstruction.