体外循环非心脏手术的麻醉(附8例病例分析)

Anesthetic management for non-cardiac operation under cardiopulmonary bypass

目的 总结体外循环非心脏手术病人的术前评估与麻醉。方法 回顾性分析了 8例病人的 9次体外循环行非心脏手术的麻醉情况 ,其中 6次经左或右股动、静脉、1次右经锁骨下动、静脉建立部分体外循环 ,2次常规体外循环。结果 该组病人平均体外循环时间 96～ 1 84 (1 31± 31 )min ,平均手术时间 4～ 9.5 (5 .9± 1 .8)h ,平均出血量 6 0 0～ 35 0 0 (1 35 0± 96 7)ml,平均输血量 4 0 0～ 30 0 0 (95 0± 886 )ml,平均尿量 4 0 0～ 1 80 0 (1 0 0 1± 4 5 0 )ml,术后平均呼吸支持时间 4 .5～ 96 (2 8.5± 30 .8)h。 1例病人术后 4 2d死于多器官功能不全综合征。结论 体外循环用于呼吸道难于维持、循环功能难于稳定或特殊要求的病人具有明显优点 ,加强麻醉前评估和麻醉管理有利于麻醉。

Objective To summarize preoperative evaluation and anesthesia in patients of non cardiac operation under cardiopulmonary bypass(CPB).Methods 9 times of anesthesia for 8 patients of non cardiac operation under cardiopulmonary bypass were analyzed retrospectively,in which cardiopulmonary bypass was set up in six times by left or right thigh artery to thigh vein and in two times by right subclavian artery to subclavian vein partially,and in two times commonly.Results The mean time of CPB was (131±31)min(96～184min) and the mean time of operation was( 5.9±1.8)h(4～9.5h),the average bleed was (1 350±967)ml(600～3 500ml) and the average transfusion was (950±886)ml(400～3 000ml),and the mean urine output was 1 001±450ml(400～1 800ml) and the average time of respiratory support was (28.5±30.8)h(4.5～96h) postoperation,one patient died of multiple organ dysfunction at 42 days after operation.Conclusion More virtues of cardiopulmonary bypass might have been confirmed in patients with difficult airway,unstable circulatory function or other special patients,and the augmentation of pre anesthesia evaluation and anesthetic management is advantageous for anesthesia and operation success.