覆膜支架介入治疗主动脉瘤的麻醉处理

Anesthesia for endovascular stent-graft repair of aortic aneurysm

目的 探讨覆膜支架介入治疗主动脉瘤的麻醉处理。方法 2例胸腹主动脉瘤患者均在全身麻醉和控制性降压下施行经股动脉覆膜支架介入治疗主动脉瘤术。麻醉采用异丙酚为主的全凭静脉麻醉 (异丙酚靶控输注 ) ,持续监测心电图、脉搏血氧饱和度、中心静脉压、呼气末CO2 分压和尿量。以硝普钠 0 .3～ 1 .0 μg·kg-1 ·min-1 控制术中收缩压在 1 2 0mmHg(1mmHg =0 1 33kPa)以下 ,在释放支架时将收缩压控制在 90mmHg以下。结果 手术及麻醉时间分别为 1 5 0min和 1 2 0min ,麻醉效果满意 ,血流动力学平稳。术中动脉收缩压 1 1 0 2 5～ 1 2 0mmHg ,HR6 0～ 70次 /min ;释放支架时收缩压 80 2 5mmHg ,平均动脉压6 0mmHg ,HR6 0次 /min。术中和术后未发生麻醉相关并发症。结论 全身麻醉及控制性降压用于覆膜支架介入治疗主动脉瘤效果良好。

Objective To present the anesthetic management of patients for endovascular stenting of aortic aneurysm.Methods Two patients with aortic aneurysm were underwent endovascular repair of abdominal and thoracic aortic aneurysms under general anesthesia and reduced hypotension.Anesthesia was induced with midazolam,fentanyl and vecuronium,and maintained with a computerized target controlled infusion(TCI)device for propofol and intravenous application of fentanyl and vecuronium.A radial arterial line,a two lumen central venous catheter,and a urinary Foley catheter were placed.Continuous electrocardiogram,invasive and noninvasive blood pressure,central venous pressure,transcutaneous oxygen saturation,end tidal carbon dioxide concentration and urine output were monitored.An intravenous infusion of sodium nitroprusside(0.3～1.0μg·kg -1 ·min -1 )was given to achieve systolic pressure below 120mm Hg during operation,and maintain at less than 90mm Hg before release of the stent.Results There were no difference in the hemodynamics during and pre anesthesia.Arterial systolic pressure was maintained at 110.25 to 120mm Hg and heart rate at 60 to 70 beat/min.Before release of the stent,systolic pressure was reduced to 80.25mm Hg,mean arterial pressure 60mm Hg and heart rate 60 beat/min.Total anesthetic and surgery times were 150 min and 120 min.There was no intraoperative surgical or anesthetic complication.Conclusion General anesthesia with controlled hypotension is a satisfactory anesthetic technique for endovascular stent graft repair of aortic aneurysm.The anesthetic considerations for endovascular aortic repair should focus on stable hemodynamics.