60岁以上患者心脏瓣膜置换术的麻醉

Anesthetic management for patients over 60 years of age undergoing cardiac valve replacement

目的 总结 4 5例 6 0岁以上老年心脏瓣膜置换术围术期的麻醉处理经验。方法 采用芬太尼 30 μg/kg、咪唑安定0 .2～ 0 .3mg/kg、维库溴铵 0 .6～0 .85mg/kg进行麻醉 ,术后适量给予血管活性药物支持循环功能及延长术后拔管时间等措施。结果 麻醉诱导期血流动力学与诱导前相比较无明显改变 (P >0 .0 5 ) ,诱导后 ,气管插管时 ,插管后各组间血流动力学无明显变化 (各组间P >0 .0 5 )。术后死亡 4例 ,1例死于术后急性肾功能衰竭、1例死于顽固性心衰、2例死于低心排。死因与术前伴有其它脏器功能减退和主动脉阻断时间较长有关。术后呼吸支持时间平均为 (2 5 .3± 8.2 )h。结论 中等剂量芬太尼适用于老年心脏瓣膜患者。

Objective To summarize the experiences on the anesthetic management of patients over 60 years of age undergoing cardiac valve replacement.Methods 45 cases over 60 years of age were anesthetized in fentanyl 30μg/kg,midazolam 0.2～0.3mg/kg and vecuronium 0.6～0.85mg/kg.Vasoactive drugs were used when necessary to support the circulation.Results There were no difference ( P >0.05) in the hemodynamics during and pre anesthesia.4 patients died of acute renal failure,refractory heart failure and low cardiac output syndrome respectively.The death were related to the organ dysfunction befor the operation,and the prolonged duration aortic cross clamping.The mean postoperative ventilation time was (25.3±8.2)h.Conclusion Moderate dosage of fentanyl is eligible for elderly patients.Vasoactive and postoperatively prolonged ventilation therapy should be given appropriately