世居高原患者在低海拔地区行心脏手术的麻醉管理

Anesthesia management for plateau natives undergoing cardiac surgery at low altitude area

目的回顾并总结世居高原患者在低海拔地区行心脏手术的麻醉管理经验。方法收集2013年1月至2018年12月在四川省人民医院行心脏手术的世居高原患者101例。记录术前(T1)、体外循环结束(T2)、手术结束(T3)时的血红蛋白(Hb)和乳酸值(Lac)变化,手术前后肺动脉高压(PH)情况和脑钠肽(BNP)浓度。采用Logstic回归分析患者出现早期并发症的危险因素。结果体外循环结束时Hb较术前下降,同时Lac升高,根据患者氧供需输血后Hb升高、Lac下降(P<0.05)。术后诊断PH患者减少,BNP升高无统计学意义。9例患者出现术后早期并发症,Logistic回归分析显示高龄是患者发生并发症的独立危险因素(P<0.05)。结论长期处于低压缺氧状态的高原患者产生适应性的病理生理改变,特别是Hb浓度和肺动脉压力的升高。维持适宜的Hb浓度、加强对PH的识别处理是高原心脏手术患者麻醉管理的重点,个体化的麻醉管理有利于减少患者术后早期并发症发生的危险因素。

Objective To summarize the experience of anesthesia management for plateau natives undergoing cardiac surgery at low altitude area.Methods Clinical data of 101 high plateau native patients undergoing cardiac surgery from January 2013 to December 2018 in Sichuan Provincial People's Hospital were retrospectively analyzed.The data of hemoglobin (Hb),lactic acid (Lac),pulmonary hypertension before and after operation (PH) and brain natriuretic peptide (BNP) were recorded at pre-operation (T1),at the end of cardiopulmonary bypass (T2) and at the end of operation (T3).Logistic regression analysis was applied to predict the risk factors for early postoperative complication.Results Compared to preoperative status,Hb was decreased and Lac was increased significantly after cardiopulmonary bypass.Lac was decreased after transfusion to adjust Hb according to the patient's oxygen supply ( P <0.05).Postoperative diagnosis of PH was decreased and there was no statistical significance in BNP increase.There were 9 patients with early postoperative complication.Logistic regression analysis showed that old age was the independent risk factor of early postoperative complications ( P < 0.05).Conclusion People at high altitude are in hypobaric hypoxia state for long time,which produces adaptive pathophysiological changes.Maintaining appropriate Hb and strengthening the identification and treatment for PH are key points to anesthesia management during perioperative period.Individualized anesthesia management contributes to reduction of the risk factor of early postoperative complications.