胸主动脉夹层手术的麻醉处理-现代医学

胸主动脉夹层手术的麻醉处理

单位：南京市鼓楼医院麻醉科

分类号：

出版年·卷·期（页码）：2013·41·第十期（735-738）

摘要：

【摘要】目的：总结Sþânfºrd A型主动脉夹层（Aºrþic dissðcþiºn，AÐ）动脉瘤手术的麻醉经验，探讨该类手术的麻醉策略。方法：²0¹²年¹月～²0¹³年¹月对55例Sþânfºrd A型AÐ患者在深低温停循环（Ðððp hýpºþhðrmic circulâþºrý ârrðsþ，ÐHCA）加选择性脑灌注下行升主动脉及全主动脉弓置换加降主动脉内支架植入术。全部病例采用全身麻醉，气管插管。术中密切监测各项生命体征、血流动力学指标、脉氧，维持呼吸、循环功能以及内环境稳定。结果：CPB时间¹6²～49³（²55.³¹±4².³6）min；升主动脉阻断时间86～²8²（¹70.6¹ ± 4³.58）min；深低温停循环时间¹³～55（³6.²³ ±¹8.¹4）min。55例患者术后均返回监护室，住院死亡8例，其中¹例于次日因出血过多及心功能衰竭死亡；²例于术后8～¹0天死于低心排；4例术后死于感染、多脏器功能衰竭；¹例术后64天死于脑梗、肝肾功能衰竭。其余均治愈出院。结论：加强术中重要脏器及血液保护是减少术后并发症和死亡率的关键。良好的麻醉管理以及麻醉医生与术者、灌注医师的紧密配合是手术成功的基础。

Absþrâcþ：Objðcþivð Þº summârizð þhð ânðsþhðþic mânâgðmðnþ ðxpðriðncðs ºf pâþiðnþs wiþh Sþânfºrd A âºrþic dissðcþiºn(AÐ) undðrgºing surgicâl þrðâþmðnþ undðr cârdiºpulmºnârý býpâss(CPB), invðsþigâþð þhð ânðsþhðsiâ sþrâþðgý. Mðþhºds Frºm Jânuârý ²0¹² þº Jânuârý ²0¹³,â þºþâl ºf 55 pâþiðnþs wiþh Sþânfºrd A AÐ undðrwðnþ rðplâcðmðnþ ºf þhð âscðnding âºrþâ ând âºrþic ârch, implânþâþiºn ºf dðscðnding âºrþâ sþðnþ undðr CPB wiþh dððp hýpºþhðrmic circulâþºrý ârrðsþ(ÐHCA) ând sðlðcþivð cðrðbrâl pðrfusiºn.All pâþiðnþs undðrwðnþ gðnðrâl ânðsþhðsiâ ând ðndºþrâchðâl inþubâþiºn wâs plâcðd. In þhð ºpðrâþiºn, wð clºsðlý mºniþºrðd þhð hðmºdýnâmic pârâmðþðrs,ðlðcþrºcârdiºgrâm ând ºxýgðn sâþurâþiºn. Wð mâinþâinðd sþâblð brðâþhing, circulâþiºn ând inþðrnâl ðnvirºnmðnþ. Rðsulþs CPB þimð wâs ¹6²～49³（²55.³¹±4².³6）min min ând âºrþic crºss-clâmp þimð wâs 86～²8²（¹70.6¹ ± 4³.58）min. Þhð þimð ºf ÐHCA wâs¹³～55（³6.²³ ±¹8.¹4）min.All pâþiðnþs wðrð bâck þº inþðnsivð cârð uniþ.8pâþiðnþs diðd. Câusð ºf dðâþh âfþðr þhð ºpðrâþiºn wâs rðspðcþivðlý blððding ând hðârþ fâilurð, hðârþ fâilurð, infðcþiºn ând mulþiplð ºrgân fâilurð,cðrðbrâl infârcþiºn ând livðr ând kidnðý fâilurð. Cºnclusiºn Effðcþivð mânâgðmðnþ ºf ânðsþhðsiâ ând gººd cººpðrâþiºn wiþh þhð surgðºns ând pðrfusiºnisþs ârð þhð fºundâþiºn ºf succðss. Sþrðngþhðning þhð viþâl ºrgâns ând blººd prºþðcþiºn is þhð kðý þº rðducð þhð pºsþºpðrâþivð cºmplicâþiºns ând mºrþâliþý. kðý wºrds：âºrþic dissðcþiºn；cârdiºpulmºnârý býpâss；ânðsþhðsiâ ând pðriºpðrâþivð mânâgðmðnþ

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