深低温停循环主动脉瘤根治术的麻醉(附8例分析)

Anesthesia with deep hypothermic circulatory arrest for aortic aneurysm surgery:analysis of 8 cases.

目的 回顾性总结深低温停循环主动脉瘤根治术的麻醉处理方法。方法 分析 8例深低温停循环情况下施行胸腹主动脉瘤手术患者的麻醉、监测、循环管理和脑保护的情况。结果 该组病人 8例 ,平均体外循环时间为 (1 73± 4 6 )min ,平均深低温停循环时间为 (31 .7± 1 2 .4 )min ,停循环时平均温度为 (1 7.1± 1 .3)℃ ,术中平均失血量为 (2 380± 730 )ml,术中平均输血量为 (1 2 70± 4 6 0 )ml,术后病人平均苏醒时间为 (1 3.9± 5 .4 )h ,2例病人术后 1周内有轻微神经系统症状 ,其余病人无明显神经系统异常。结论 深低温停循环主动脉瘤根治术的麻醉应着重强调麻醉诱导平稳、循环功能的稳定、限制停循环时间。

Objective To retrospectively summarize the experience of anesthetic management with deep hypothermic circulatory arrest (DHCA) for aneurysm surgery.Methods Anesthesia, monitoring ,circulatory management and brain protection of 8 consecutive patients undergoing elective or emergency aneurysm surgery requiring DHCA were analyzed.Results The average CPB time,the mean duration of circulatory arrest ,the mean temperature at time of arrest , the average blood loss ,the mean blood transfusion and the average awake time from anesthesia were (173±46)min, (31.7±12.4)min,(17.1±1.3)℃, (2 380±730)ml,(1 270±460)ml and (13.9±5.4)h respectively .Two patients manifestated mild central nervous system symptoms and other patients had no neurologic abnormalities.Conclusion The anesthetic management with deep hypothermic circulatory arrest (DHCA) for aneurysm surgery might emphasize on smoothing anesthesia induction,stabilizing circulatory function,limiting the time of circulatory arrest, protecting brain and balancing internal environmemnt.