全身麻醉用于经皮肺动脉瓣植入术的效果

Efficacy of general anesthesia for percutaneous pulmonary valve implantation

目的总结全身麻醉用于经皮肺动脉瓣植入术(PPVI)的效果。方法回顾性分析2017年12月至2020年1月河南省人民医院儿童心脏中心全身麻醉下PPVI患者6例的临床资料。于麻醉诱导前(T_(1))、麻醉诱导后(T_(2))、手术开始前(T_(3))、肺动脉瓣植入前(T_(4))、肺动脉瓣植入时(T_(5))、肺动脉瓣植入后即刻(T_(6))和出手术室(T_(7))时记录SBP、DBP、HR、CVP、SpO_(2)和局部脑氧饱和度(rSO_(2))。于T_(4)和T_(6)时记录右心室收缩压(SRVP)和舒张压(DRVP)、肺动脉收缩压(SPAP)和舒张压(DPAP)。记录术中有关并发症的发生情况。记录术前术后心肝肾功能等。记录术后气管导管拔除时间、ICU停留时间和住院时间等。结果男性3例,女性3例,年龄(16±4)岁,体重(41±12)kg。与T_(1)~4和T_(6),7时比较,T_(5)时SBP、DBP、HR、rSO_(2)和SpO_(2)降低(P<0.05);与T_(1)~5时比较,T_(6),7时CVP降低(P<0.05);与T_(4)时比较,T_(6)时DRVP降低,DPAP升高(P<0.05)。所有患者未见麻醉和手术相关严重并发症发生。1例患者手术室内拔除气管导管后转入病房,5例患者术后转入ICU。6例患者均顺利出院,进入随访阶段。结论全身麻醉用于PPVI的效果较好,肺动脉瓣植入过程中应加强对肺循环和体循环血流动力学的监测,维持循环功能稳定。

Objective To summarize the efficacy of general anesthesia for percutaneous pulmonary valve implantation(PPVI).Methods The clinical data of 6 patients underwent PPVI under general anesthesia in Children′s Heart Center of Henan Provincial People′s Hospital from December 2017 to January 2020 were retrospectively analyzed.Systolic blood pressure,diastolic blood pressure,heart rate,central venous pressure,SpO_(2) and regional cerebral oxygen saturation were recorded before anesthesia induction(T_(1)),after anesthesia induction(T_(2)),before beginning of surgery(T_(3)),before pulmonary valve implantation(T_(4)),during pulmonary valve implantation(T_(5)),immediately after pulmonary valve implantation(T_(6))and when the patients left the operating room(T_(7)).Right ventricular systolic pressure,diastolic pressure,pulmonary artery systolic pressure and diastolic pressure were recorded at T_(4) and T_(6).The development of related complications during operation and the cardiac,liver and kidney functions before and after operation were recorded.The postoperative extubation time,intensive care unit stay time and hospital stay time were recorded.Results Six patients(3 males,3 females),aged(16±4)yr,weighing(41±12)kg,were analyzed.Compared with the value at T_(1)-4 and T_(6),7,systolic blood pressure,diastolic blood pressure,heart rate,regional cerebral oxygen saturation and SpO_(2) were significantly decreased at T_(5)(P<0.05).Compared with the value at T_(1)-5,central venous pressure was significantly decreased at T_(6),7(P<0.05).Compared with the value at T_(4),right ventricular diastolic pressure was significantly decreased,and pulmonary artery diastolic pressure was increased at T_(6)(P<0.05).No anesthesia-and surgery-related serious complications occurred among the patients.One patient was transferred to the ward after extubation in the operating room,and 5 patients were transferred to the intensive care unit after operation.All 6 patients were discharged successfully and entered the follow-up stage.Conclusion General anesthesia provides better efficacy when used for PPVI,and hemodynamic monitoring of pulmonary circulation and systemic circulation should be strengthened during pulmonary valve implantation to maintain circulation stable.