原位同种异体心脏移植术的麻醉管理

Anesthetic management for patients undergoing orthotopic heart transplantation

目的 :探讨 8例原位同种异体心脏移植术的麻醉管理。方法 :术前依据患者心脏功能及全身状况 ,给予强心、利尿、营养心肌等治疗。采用静脉吸入复合麻醉 ,气管插管控制呼吸 ,在体外循环下行原位异体心脏移植术。根据血流动力学监测选用合适剂量的血管活性药。结果 :8例患者术中的血流动力学平稳 ,术毕 6～ 14h拔除气管导管 ,无麻醉并发症。 2例患者分别于术后 17d和 72 d死亡 ,余 6例患者均存活。结论 :重视术前心功能准备 ,合理使用麻醉药和血管活性药物 ,维持术中的血流动力学平稳是原位异体心脏移植术麻醉的关键。

AIM: To summarize the anesthetic management for 8 patients undergoing orthotopic heart transplantation. METHODS: According to preoperative cardiac function and general status of the patients, myocardial nutrition management, improvement of cardiac function and diuresis were taken. Orthotopic heart transplantation was performed on all the patients under combined intravenous-inhalational general anesthesia. Tracheal intubation was performed for mechanical ventilation during the anesthesia. The operation was performed with the aid of extracorporeal circulation. Vasoactive drugs were used based on hemodynamic data. RESULTS: The hemodynamics of the 8 patients were stable. Tracheal intubation were remained 6～14 hours after the operation. All patients had no anesthetic complications. Two patients died 17 and 72 days respectively after the operation. The remaining 6 patients survived healthily. CONCLUSION:Particular attention to the improvement of cardiac function before operation, proper vasoactive drugs and anesthetics, and the maintenance of hemodynamic stability during the procedure are the fundamentals of the anesthesia for orthotopic heart transplantation.