急性A型主动脉夹层手术的超快通道麻醉管理

Ultra-fast-track anesthesia management for surgeries for acute type A aortic dissection

收集2023年8月至2023年12月南京医科大学第二附属医院16例超快通道麻醉下行急性A型主动脉夹层手术患者的临床资料,分析及总结麻醉管理经验。超快通道麻醉策略:通过体外循环方法、药物等减少围术期患者炎症反应和进行多器官保护,再根据手术进程,精确使用长/短效麻醉药物,实现手术结束后即刻清醒;使用深麻醉气管拔管、瑞芬太尼输注技术和经鼻高流量通气,使患者在安全、低应激下拔除气管导管。所有患者均顺利完成麻醉诱导和麻醉维持,手术时间(413±92)min,麻醉时间(480±100)min,体外循环时间(168±42)min,心脏阻断时间(119±36)min,深低温停循环时间(24±5)min。14例患者采用深低温停循环联合腋动脉单侧脑灌注的体外循环方式,2例患者采用深低温停循环联合上腔静脉逆行脑灌注的体外循环方式。所有患者于术后30 min内拔除气管导管,拔管前后血气分析和血流动力学指标均在正常范围内或相对正常范围内。术后ICU滞留时间6(3,11)d,总住院时间(23±8)d。7例患者因发生术后并发症总住院时间超过20 d。所有患者康复出院。超快通道麻醉策略应用于急性A型主动脉夹层患者是安全可行的,可以实现手术室内即刻气管拔管。

The clinical data from 16 patients who underwent surgery for acute type A aortic dissection under ultra-fast-track anesthesia(UFTA)in the Second Affiliated Hospital of Nanjing Medical University from August 2023 to December 2023 were collected,and the experience of anesthesia management was analyzed and summarized.UFTA strategy was to reduce inflammation and perform multi-organ protection in the perioperative period through cardiopulmonary bypass methods,medications,etc.According to the process of operation,the long-term and short-acting anesthetic drugs were accurately used to achieve the patient′s awakening immediately after the operation.Deep anesthesia extubation,remifentanil infusion techniques,and nasal high-flow ventilation were used to enable patients to be removed from the endotracheal tube with low stress under the premise of safety.All the patients successfully completed anesthesia induction and anesthesia maintenance.The average surgery duration was(413±92)min,the average anesthesia duration was(480±100)min,the cardiopulmonary bypass time was(168±42)min,the cardiac arrest time was(119±36)min,and the deep hypothermic circulatory arrest lasted(24±5)min.Of these patients,14 underwent deep hypothermic circulatory arrest combined with unilateral cerebral perfusion via the right axillary artery,and 2 underwent deep hypothermic circulatory arrest combined with retrograde cerebral perfusion via the superior vena cava.All the patients had their tracheal tubes removed within 30 min postoperatively,with blood gas analysis and hemodynamics being within or close to normal ranges.The average postoperative intensive care unit stay time was 6(3,11)days,and the total length of hospital stay was(23±8)days.The total hospitalization time extended 20 days in 7 patients due to postoperative complications.All the patients recovered and were discharged.In conclusion,the application of UFTA strategy is safe and feasible in the patients with acute type A aortic dissection,allowing for immediate extubation in the operating room.