心肺联合移植后肾移植术的麻醉

Anesthesia for renal transplantation in heart-lung transplant patient

目的探讨心肺联合移植后肾移植的麻醉管理。方法回顾性分析1例心肺联合移植后肾移植术的麻醉经过。结果患者为21岁男性,心肺移植后35天行肾移植术。手术历时160分钟,术中失血量约300ml,输6%羟乙基淀粉500ml,林格氏液400ml。采用全凭静脉麻醉,麻醉诱导为咪达唑仑1mg,芬太尼5μg/kg,乙咪酯0.2mg/kg,维库溴铵0.1mg/kg静脉注射,维持以芬太尼0.1～0.2μg●kg-1●min-1,咪达唑仑0.5～1μg●kg-1●min-1,维库溴铵0.4～0.8μg●kg-1●min-1微泵持续输注,并根据血流动力学的改变程度选用血管活性药物。术后2.5小时患者清醒,手术后第一天尿量3085ml,第二天2664ml。结论术前要熟悉患者病史、移植心肺的病理生理变化及其功能,制定周密的麻醉方案,了解各种麻醉和治疗用药对去神经心肺的作用。完善的血流动力学监测,并在维持移植肾有效灌注压的同时保护心肺功能是麻醉处理的关键。

Objective To study the anesthetic management for renal transplantation followingheart-lung transplantation.MethodsAnesthetic management for one case of renal transplantationafter heart-lung transplantation was discussed retrospectively.ResultsThe patient was a21-year-old man,which underwent the renal transplantation on 35th day after heart-lungtransplantation. The operation lasted 160 minutes and blood loss was 300ml.6% hydroxyethylstarch 500ml and Ringer solution 400ml were transfused respectively. Cardioactive drugs wereused to maintain the stabilization of circulation and furose mide was intravenously injected afterthe vascular clamps of transplanted kidney were released.Consciousness recovered at postoperative2.5 hours.The volume of urine was 3085ml in the first 24 hours after surgery , 2664mlin the second day.ConclusionIt is very important to understand the patient history andreview the pathophysiology and functions of denervated heart and lung, the altered effects ofanesthetics and cardioactive drugs by denervation.Favorable preanesthetic preparations, suitableanesthetic treatments, adequate monitors of hemodynamics, the well maintained balancebetween efficient renal perfusion and protections of transplanted heart and lung, are vital toanesthetic management for renal transplantation following heart-lung transplantation.