胸腔镜下先天性双主动脉弓矫治术的麻醉处理5例

Anesthetic management of thoracoscopic correction of congenital double aortic arch in five children:a case report

先天性双主动脉弓是先天性血管环畸形中最常见的一种血管畸形,较早出现气管压迫症状。文章报道了5例胸腔镜下双主动脉弓矫治术的麻醉管理。该类患儿术前CT提示气道狭窄<50%,5例均采用静脉快诱导气管插管,支气管封堵器管外法实施单肺通气,5例患儿插管顺利且能耐受单肺通气。单肺通气建立之初1例患儿氧合出现短暂下降,可能为肺内分流增加所致,关闭七氟醚后氧合恢复。夹闭主动脉弓前30 min开始缓慢进行控制性降压并保证有效血容量,维持平均动脉压在50~60 mmHg(1 mmHg=0.133 kPa),关注呼吸动力学及血流动力学变化,重视协助外科医师做阻断试验。术后顺利拔除气管导管,经治疗后出院。

Congenital double aortic arch is one of the most common vascular anomalies in congenital vascular ring,which often presents early tracheal compression symptoms.The article reports on the anesthetic management of five children who underwent thoraco‑scopic correction of double aortic arch.Preoperative CT in these children indicated tracheal stenosis of less than 50%.All the patients were intubated after rapid intravenous induction,and single‑lung ventilation was achieved using the bronchial blocker extrathoracic method.The intubation was successful in all the children,where single‑lung ventilation was tolerable.At the beginning of single‑lung ventilation,one child experienced a temporary decrease in oxygenation,which may result from increasing intrapulmonary shunting,and oxygenation recovered after discontinuation of sevoflurane.Controlled hypotension was slowly induced 30 min before the aortic arch was clipped to ensure effective blood volume,where the mean arterial pressure was maintained at 50−60 mmHg(1 mmHg=0.133 kPa),atten‑tion was drawn on the changes in respiratory dynamics and hemodynamics,as well as assistance to the surgeon during the clipping pro‑cess.The tracheal tube was successfully withdrawn after the operation,and the children were discharged after treatment.