急诊体外循环心血管手术病人的麻醉(附20例病例分析)

Anesthesia for patients with cardiovascular surgery under emergency cardiopulmonary bypass.

目的 总结急诊体外循环心血管手术的麻醉。方法 回顾性分析了本科 1 996年 1 2月～ 2 0 0 3年 3月 2 0例急诊体外循环心血管手术的麻醉前准备、麻醉诱导方法、循环功能维护和并发症防治等问题。该组病人麻醉前心功能分级 (NYHA1 )心功能Ⅲ级 8例 ,Ⅳ级 1 2例 ,心源性休克 4例 ,采用小剂量咪唑安定、氯胺酮、芬太尼、万可松多次给药 ,复合利多卡因咽喉部表面麻醉作麻醉诱导 ,术中用GIK溶液或二磷酸果糖作心肌保护。结果 该组病人麻醉诱导基本平稳、血流动力学相对稳定 ,术后低心排4例 (2 0 .0 % ,4 /2 0 ) ,1例肾功能不全 (5 .0 % ,1 /2 0 ) ,2例呼吸功能不全 (1 0 .0 % ,2 /2 0 ) ,3例死亡 (1 5 .0 % ,3/2 0 )。结论 急诊体外循环心血管手术的麻醉应着重强调麻醉前心血管功能的维护、对循环干扰小的麻醉诱导、术中心肌和重要脏器功能保护以及术后的呼吸。

Objective To summarize anesthesia for patients with cardiovascular surgery under emergency cardiopulmonary bypass.Methods Preanesthetic preparation,anesthesia induction,circulatory maintenance and prevention of complications in 20 cases with cardiovascular surgery under emergency cardiopulmonary bypass from Dec,1996 to Mar,2003 were analyzed retrospectively. the preoperative cardiac functional classification with NYHA1 showed 8 cases in III grade and 12 cases in IV grade and 4 cases with cardiogenic shock in 20 cases,all patients were induced with low dosages of midazolam,ketamine,fentanyl and vecuronium in many times combined with laryngpharynx surface anesthesia by lidocaine,GIK solution or fructose disphosphate (FDP) during operation were used for myocardial preservation.Results Stable anesthesia induction and hemodynamics were reached in all patients, 4 cases of low cardiac output,one case of acute renal failure and two cases of respiratory dysfunction were occurred postoperation ,and 3 patients were dead and the total mortality was 15.0% .Conclusion Anesthesia for patients with cardiovascular surgery under emergency cardiopulmonary bypass might emphasize maintenance of circulatory function before anesthesia,anesthesia induction with small circulatory disturbance, protection of myocardium and main organs during operation,and cardiopulmonary support postoperation.